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Routine HIV Screening in France: Clinical Impact and Cost-Effectiveness

Author

Listed:
  • Yazdan Yazdanpanah
  • Caroline E Sloan
  • Cécile Charlois-Ou
  • Stéphane Le Vu
  • Caroline Semaille
  • Dominique Costagliola
  • Josiane Pillonel
  • Anne-Isabelle Poullié
  • Olivier Scemama
  • Sylvie Deuffic-Burban
  • Elena Losina
  • Rochelle P Walensky
  • Kenneth A Freedberg
  • A David Paltiel

Abstract

Background: In France, roughly 40,000 HIV-infected persons are unaware of their HIV infection. Although previous studies have evaluated the cost-effectiveness of routine HIV screening in the United States, differences in both the epidemiology of infection and HIV testing behaviors warrant a setting-specific analysis for France. Methods/Principal Findings: We estimated the life expectancy (LE), cost and cost-effectiveness of alternative HIV screening strategies in the French general population and high-risk sub-populations using a computer model of HIV detection and treatment, coupled with French national clinical and economic data. We compared risk-factor-based HIV testing (“current practice”) to universal routine, voluntary HIV screening in adults aged 18–69. Screening frequencies ranged from once to annually. Input data included mean age (42 years), undiagnosed HIV prevalence (0.10%), annual HIV incidence (0.01%), test acceptance (79%), linkage to care (75%) and cost/test (€43). We performed sensitivity analyses on HIV prevalence and incidence, cost estimates, and the transmission benefits of ART. “Current practice” produced LEs of 242.82 quality-adjusted life months (QALM) among HIV-infected persons and 268.77 QALM in the general population. Adding a one-time HIV screen increased LE by 0.01 QALM in the general population and increased costs by €50/person, for a cost-effectiveness ratio (CER) of €57,400 per quality-adjusted life year (QALY). More frequent screening in the general population increased survival, costs and CERs. Among injection drug users (prevalence 6.17%; incidence 0.17%/year) and in French Guyana (prevalence 0.41%; incidence 0.35%/year), annual screening compared to every five years produced CERs of €51,200 and €46,500/QALY. Conclusions/Significance: One-time routine HIV screening in France improves survival compared to “current practice” and compares favorably to other screening interventions recommended in Western Europe. In higher-risk groups, more frequent screening is economically justifiable.

Suggested Citation

  • Yazdan Yazdanpanah & Caroline E Sloan & Cécile Charlois-Ou & Stéphane Le Vu & Caroline Semaille & Dominique Costagliola & Josiane Pillonel & Anne-Isabelle Poullié & Olivier Scemama & Sylvie Deuffic-Bu, 2010. "Routine HIV Screening in France: Clinical Impact and Cost-Effectiveness," PLOS ONE, Public Library of Science, vol. 5(10), pages 1-9, October.
  • Handle: RePEc:plo:pone00:0013132
    DOI: 10.1371/journal.pone.0013132
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    References listed on IDEAS

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    1. A. David Paltiel & Julie A. Scharfstein & George R. Seage & Elena Losina & Sue J. Goldie & Milton C. Weinstein & Donald E. Craven & Kenneth A. Freedberg, 1998. "A Monte Carlo Simulation of Advanced HIV Disease," Medical Decision Making, , vol. 18(2_suppl), pages 93-105, April.
    2. Bruce R. Schackman & Sue J. Goldie & Kenneth A. Freedberg & Elena Losina & John Brazier & Milton C. Weinstein, 2002. "Comparison of Health State Utilities Using Community and Patient Preference Weights Derived from a Survey of Patients with HIV/AIDS," Medical Decision Making, , vol. 22(1), pages 27-38, February.
    3. S. Deuffic-Burban & D. Costagliola, 2006. "Including pre-AIDS mortality in back-calculation model to estimate HIV prevalence in France, 2000," Post-Print hal-00199750, HAL.
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    Cited by:

    1. Kartik K Venkatesh & Jessica E Becker & Nagalingeswaran Kumarasamy & Yoriko M Nakamura & Kenneth H Mayer & Elena Losina & Soumya Swaminathan & Timothy P Flanigan & Rochelle P Walensky & Kenneth A Free, 2013. "Clinical Impact and Cost-Effectiveness of Expanded Voluntary HIV Testing in India," PLOS ONE, Public Library of Science, vol. 8(5), pages 1-11, May.
    2. Bert, Fabrizio & Gualano, Maria Rosaria & Biancone, Paolo & Brescia, Valerio & Camussi, Elisa & Martorana, Maria & Secinaro, Silvana & Siliquini, Roberta, 2018. "Cost-effectiveness of HIV screening in high-income countries: A systematic review," Health Policy, Elsevier, vol. 122(5), pages 533-547.
    3. Olanrewaju Medu & Adegboyega Lawal & Doug Coyle & Kevin Pottie, 2021. "Economic evaluation of HIV testing options for low-prevalence high-income countries: a systematic review," Health Economics Review, Springer, vol. 11(1), pages 1-11, December.
    4. Yazdan Yazdanpanah & Julian Perelman & Madeline A DiLorenzo & Joana Alves & Henrique Barros & Céu Mateus & João Pereira & Kamal Mansinho & Marion Robine & Ji-Eun Park & Eric L Ross & Elena Losina & Ro, 2013. "Routine HIV Screening in Portugal: Clinical Impact and Cost-Effectiveness," PLOS ONE, Public Library of Science, vol. 8(12), pages 1-1, December.

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