Tuesday, March 15, 2016

Economic & Health Implications from Earlier Detection of HIV Infection in the United Kingdom

Purpose: 
To model the budget and survival impact of implementing interventions to increase the proportion of HIV infections detected early in a given UK population.

Patients and methods: 
A Microsoft Excel decision model was designed to generate a set of outcomes for a defined population. Survival was modeled on the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study extrapolated to a 5-year horizon as a constant hazard. Hazard rates were specific to age, sex, and whether detection was early or late. The primary outcomes for each year up to 5 years were: annual costs, numbers of infected cases, hospital admissions, and surviving cases. Three locations in the UK were chosen to model outcomes across a range of HIV prevalence areas: Lambeth, Southwark, and Lewisham (LSL), Greater Manchester Cluster (GMC), and Kent and Medway (K&M).

Results: 
In LSL, the projected cumulative cost savings over 5 years were £3,210,206 or £5,290,206 when including the value of the 104 life-years saved. Savings were insensitive to transmission rates, but sensitive in direct proportion to the percentage shift from late to early detection. In GMC, savings were in a similar proportion to LSL, but the magnitude was smaller, as a consequence of the lower base-case HIV prevalence. In K&M, with a smaller population and lower HIV prevalence than GMC, savings were commensurately smaller (£733,202 cumulatively over 5 years).

Conclusion: 
The results strengthen the rationale for implementing increased testing in high prevalence areas. However, in areas of low prevalence, it is unlikely that costs will be returned over a 5-year period.

Purchase full article at:   https://goo.gl/6wGaAh

By:  Vladimir Zah,1,2 Mondher Toumi1
1Ecole Doctoral Interdisciplinaire Sciences-Sant√© (EDISS), University of Lyon, Lyon, France; 2ZRx Outcomes Research Inc., Mississauga, Canada




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