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-Santé (EDISS), University of Lyon, Lyon, France; 2ZRx
Outcomes Research Inc., Mississauga, Canada
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