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Cost-effectiveness of HIV care coordination scale-up among persons at high risk for sub-optimal HIV care outcomes

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  • Elizabeth R Stevens
  • Kimberly A Nucifora
  • Mary K Irvine
  • Katherine Penrose
  • McKaylee Robertson
  • Sarah Kulkarni
  • Rebekkah Robbins
  • Bisrat Abraham
  • Denis Nash
  • R Scott Braithwaite

Abstract

Background: A study of a comprehensive HIV Care Coordination Program (CCP) showed effectiveness in increasing viral load suppression (VLS) among PLWH in New York City (NYC). We evaluated the cost-effectiveness of a scale-up of the CCP in NYC. Methods: We incorporated observed effects and costs of the CCP into a computer simulation of HIV in NYC, comparing strategy scale-up with no implementation. The simulation combined a deterministic compartmental model of HIV transmission with a stochastic microsimulation of HIV progression, and was calibrated to NYC HIV epidemiological data from 1997 to 2009. We assessed incremental cost-effectiveness from a health sector perspective using 2017 $US, a 20-year time horizon, and a 3% annual discount rate. We explored two scenarios: (1) two-year average enrollment and (2) continuous enrollment. Results: In scenario 1, scale-up resulted in a cost-per-infection-averted of $898,104 and a cost-per-QALY-gained of $423,721. In sensitivity analyses, scale-up achieved cost-effectiveness if effectiveness increased from RR1.11 to RR1.37 or costs decreased by 41.7%. Limiting the intervention to persons with unsuppressed viral load prior to enrollment (RR1.32) attenuated the cost reduction necessary to 11.5%. In scenario 2, scale-up resulted in a cost-per-infection-averted of $705,171 and cost-per-QALY-gained of $720,970. In sensitivity analyses, scale-up achieved cost-effectiveness if effectiveness increased from RR1.11 to RR1.46 or program costs decreased by 71.3%. Limiting the intervention to persons with unsuppressed viral load attenuated the cost reduction necessary to 38.7%. Conclusion: Cost-effective CCP scale-up would require reduced costs and/or focused enrollment within NYC, but may be more readily achieved in cities with lower background VLS levels.

Suggested Citation

  • Elizabeth R Stevens & Kimberly A Nucifora & Mary K Irvine & Katherine Penrose & McKaylee Robertson & Sarah Kulkarni & Rebekkah Robbins & Bisrat Abraham & Denis Nash & R Scott Braithwaite, 2019. "Cost-effectiveness of HIV care coordination scale-up among persons at high risk for sub-optimal HIV care outcomes," PLOS ONE, Public Library of Science, vol. 14(4), pages 1-16, April.
  • Handle: RePEc:plo:pone00:0215965
    DOI: 10.1371/journal.pone.0215965
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    References listed on IDEAS

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    1. Adimora, A.A. & Schoenbach, V.J. & Doherty, I.A., 2007. "Concurrent sexual partnerships among men in the United States," American Journal of Public Health, American Public Health Association, vol. 97(12), pages 2230-2237.
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