Routine HIV screening in Portugal: clinical impact and cost-effectiveness.
PLoS One
; 8(12): e84173, 2013.
Article
em En
| MEDLINE
| ID: mdl-24367639
ABSTRACT
OBJECTIVE:
To compare the clinical outcomes and cost-effectiveness of routine HIV screening in Portugal to the current practice of targeted and on-demand screening.DESIGN:
We used Portuguese national clinical and economic data to conduct a model-based assessment.METHODS:
We compared current HIV detection practices to strategies of increasingly frequent routine HIV screening in Portuguese adults aged 18-69. We considered several subpopulations and geographic regions with varying levels of undetected HIV prevalence and incidence. Baseline inputs for the national case included undiagnosed HIV prevalence 0.16%, annual incidence 0.03%, mean population age 43 years, mean CD4 count at care initiation 292 cells/µL, 63% HIV test acceptance, 78% linkage to care, and HIV rapid test cost 6 under the proposed routine screening program. Outcomes included quality-adjusted survival, secondary HIV transmission, cost, and incremental cost-effectiveness.RESULTS:
One-time national HIV screening increased HIV-infected survival from 164.09 quality-adjusted life months (QALMs) to 166.83 QALMs compared to current practice and had an incremental cost-effectiveness ratio (ICER) of 28,000 per quality-adjusted life year (QALY). Screening more frequently in higher-risk groups was cost-effective for example screening annually in men who have sex with men or screening every three years in regions with higher incidence and prevalence produced ICERs of 21,000/QALY and 34,000/QALY, respectively.CONCLUSIONS:
One-time HIV screening in the Portuguese national population will increase survival and is cost-effective by international standards. More frequent screening in higher-risk regions and subpopulations is also justified. Given Portugal's challenging economic priorities, we recommend prioritizing screening in higher-risk populations and geographic settings.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Infecções por HIV
/
Programas de Rastreamento
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Guideline
/
Health_economic_evaluation
/
Prevalence_studies
/
Risk_factors_studies
/
Screening_studies
Limite:
Adolescent
/
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
PLoS One
Assunto da revista:
CIENCIA
/
MEDICINA
Ano de publicação:
2013
Tipo de documento:
Article
País de afiliação:
França