[A cost-utility study on HIV/AIDS 'one-stop service' pilot at county level]

Area of Science:

• Public Health
• Health Economics
• Infectious Disease Management

Background:

• The management of HIV/AIDS requires efficient and timely initiation of antiretroviral treatment (ART).
• County-level healthcare services in China face challenges in resource allocation and patient access to care.
• Integrated 'one-stop service' models are being explored to improve healthcare delivery for chronic conditions like HIV/AIDS.

Purpose of the Study:

• To evaluate the cost-utility of an integrated 'one-stop service' model for HIV/AIDS care at the county level.
• To compare the cost-effectiveness of the 'one-stop service' against the current ART initiation process.
• To assess the impact of the 'one-stop service' on ART initiation timeliness and patient outcomes.

Main Methods:

• A cost-utility analysis was performed using financial records and questionnaires from three pilot counties.
• A Markov model (Treeage Pro 2009) simulated five HIV states: infection, AIDS, receiving ART, death.
• Data on resource allocation, ART effectiveness, epidemic statistics, and health utilities were incorporated into the model.

Main Results:

• The 'one-stop service' reduced the average time from HIV diagnosis to ART initiation from 8 weeks to 10-18 days across pilot counties.
• The percentage of eligible patients receiving ART within 30 days increased significantly, ranging from 46.7% to 64.3% in County A, 40.0% to 69.4% in County B, and 9.5% to 50.0% in County C.
• While cost-utility ratios varied, the 'one-stop service' demonstrated potential for improved health outcomes with increased resource investment.

Conclusions:

• The 'one-stop service' model effectively shortens the delay between HIV diagnosis and ART initiation.
• This integrated approach improves ART initiation rates among people living with HIV (PLHIV).
• Increased investment in the 'one-stop service' is associated with greater gains in quality-adjusted life years (QALYs).