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Point-of-care CD4 testing cost-effective in resource-limited countries
Point-of-care CD4 testing at the time of HIV diagnosis may be cost-effective in resource-limited countries, according to new data published in PLOS Medicine.
“Point-of-care CD4 tests can help more people reach care,” Emily Hyle, MD, of the division of infectious diseases at Massachusetts General Hospital, said in a press release. “But it is critical to evaluate the implementation of any technology more expensive than current care to be sure the investment is a wise one. Our mathematical model, based on the situation in Mozambique, found that point-of-care CD4 testing at the time of HIV diagnosis was very cost-effective, as long as patients then have access to ART.”
Hyle and colleagues used the Cost-Effectiveness of Preventing AIDS Complications-International (CEPAC-I) model to project the costs of point-of-care CD4 testing at HIV diagnosis at a clinic in Mozambique. They then compared the projections with those of laboratory-based CD4 testing, the current standard procedure in sub-Saharan Africa. In addition to cost and cost-effectiveness, the model outcomes also included 5-year survival, life expectancy and lifetime costs.
The projected 5-year survival among patients who receive lab CD4 testing was 60.9%, which increased to 65% with point-of-care CD4 testing. The discounted life expectancy was 9.6 years for lab CD4 testing and 10.3 years for point-of-care CD4 testing. The lifetime costs per person were $2,440 for lab CD4 testing and $2,800 for point-of-care CD4 testing. The incremental cost-effectiveness ratios of point-of-care CD4 testing compared with laboratory CD4 testing is $500 per year of life saved.
“Our results hold in a diversity of conditions,” the researchers wrote. “The more expensive point-of-care CD4 strategy still offers excellent value under a wide range of plausible scenarios that represent a variety of settings in sub-Saharan Africa, including a range of linkage rates, opportunities for subsequent access to care and loss to follow-up. However, this value is realized only if ART is available for those patients who link to care, if patients remain in care, and if sufficient and sustainable funds are available for a lifetime of clinical care.”
Disclosure: The researchers report no relevant disclosures.