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

Author

Listed:
  • 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
  • Rochelle P Walensky
  • Farzad Noubary
  • Kenneth A Freedberg
  • A David Paltiel

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.

Suggested Citation

  • 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.
    • Handle: RePEc:plo:pone00:0084173
    DOI: 10.1371/journal.pone.0084173
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    References listed on IDEAS

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    1. 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.
    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. McCabe, C & Claxton, K & Culyer, AJ, 2008. "The NICE Cost-Effectiveness Threshold: What it is and What that Means," MPRA Paper 26466, University Library of Munich, Germany.
    4. 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.
    5. Livio Garattini & Katelijne Vooren, 2011. "Budget impact analysis in economic evaluation: a proposal for a clearer definition," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(6), pages 499-502, December.
    6. Andrew H. Briggs & Milton C. Weinstein & Elisabeth A. L. Fenwick & Jonathan Karnon & Mark J. Sculpher & A. David Paltiel, 2012. "Model Parameter Estimation and Uncertainty Analysis," Medical Decision Making, , vol. 32(5), pages 722-732, September.
    7. S.J. Goldie & Y. Yazdanpanah & E. Losina & M.C. Weinstein & X. Anglaret & R.P. Walensky & H.E. Hsu & A. Kimmel & C. Holmes & J.E. Kaplan & K.A. Freedberg, 2006. "Cost-effectiveness of HIV treatment in Resource-Poor Settings - The case of Côte d'Ivoire," Post-Print hal-00199992, HAL.
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    1. 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.

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