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Comprehensive & Cost Effective Laboratory Monitoring of HIV/AIDS: an African Role Model
Published on: October 31, 2010
The cost-effectiveness of expanded HIV screening in the United States
Aaron Lucas1, Benjamin Armbruster
1Department of Industrial Engineering and Management Science, Northwestern University, Evanston, IL, USA. aalucas@u.northwestern.edu
Insights
Current HIV testing guidelines are too infrequent. More frequent testing, especially in a test-and-treat approach, is cost-effective for all risk groups, improving patient outcomes and public health.
Area of Science:
- Epidemiology
- Public Health
- Mathematical Modeling
Background:
- Current Centers for Disease Control and Prevention (CDC) guidelines from 2006 recommend HIV testing frequencies that may be insufficient given advances in treatment and a test-and-treat paradigm.
- Earlier initiation of highly active antiretroviral therapy (HAART) and a shift towards immediate treatment upon diagnosis necessitate a re-evaluation of optimal HIV testing strategies.
Purpose of the Study:
- To evaluate the optimal testing frequencies for various risk groups in comparison to existing CDC recommendations.
- To determine the cost-effectiveness of more frequent HIV testing strategies.
Main Methods:
- A deterministic mathematical model was developed to optimize the balance between the societal costs of testing and the lifetime benefits of earlier HIV diagnosis.
- The model considered different risk groups based on annual incidence rates.
Main Results:
- For low-risk individuals (0.01% annual incidence), optimal testing is every 2.4 years.
- For moderate-risk (0.1% incidence) and high-risk (1.0% incidence) individuals, optimal testing frequencies are every 9 months and every 3 months, respectively.
- The incremental cost-effectiveness was favorable, with optimal policies costing $36,342/QALY for low-risk and $45,074/QALY for high-risk individuals compared to less frequent testing.
Conclusions:
- The current CDC guidelines for HIV testing are considered too conservative.
- More frequent HIV testing is a cost-effective strategy across all risk categories.
- Implementing more aggressive testing protocols can lead to better health outcomes and efficient resource allocation.
Objective:
The current Centers of Disease Control and Prevention (CDC) guidelines from 2006 recommend a one-time test for low-risk individuals and annual testing for those at high risk. These guidelines may not be aggressive enough, even for those at low risk of infection, due to the earlier initiation of HAART and a movement towards a test-and-treat environment. We evaluated the optimal testing frequencies for various risk groups in comparison to the CDC recommendations.
Methods:
We build a deterministic mathematical model optimizing the tradeoff between the societal cost of testing and the benefits over a patient's lifetime of earlier diagnosis.
Results:
Under a test-and-treat scenario with immediate initiation of HAART, the optimal testing frequency is every 2.4 years for low-risk (0.01% annual incidence) individuals; every 9 months for moderate risk (0.1% incidence) individuals; and every 3 months for high-risk (1.0% incidence) individuals. The incremental cost-effectiveness of the optimal policy is $ 36 ,342/quality-adjusted life-years (QALY) for low-risk individuals and $ 45 ,074/QALY for high-risk individuals compared with 20-year and annual testing, respectively.
Conclusion:
The current CDC guidelines for HIV testing are too conservative, and more frequent testing is cost-effective for all risk groups.
