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Primary care HIV screening cost effective, life-saving
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HIV testing at primary care facilities during registration of new patients is cost effective and saves lives through timely diagnosis, according to researchers.
Health authorities should invest in screening in all municipalities with high HIV prevalence in England, where the study was conducted, they wrote in the Lancet HIV.
“We’ve shown that HIV screening in U.K. primary care is cost effective and potentially cost saving, which is contrary to widespread belief,” study author Werner Leber, PhD, of Queen Mary University of London, said in a news release. “This is an important finding given today’s austerity. Financial pressures, particularly within local authorities’ public health budgets, mean that the costs of HIV testing are under intense scrutiny, and in some areas investment in testing has fallen.”
The researchers assessed data from a trial they previously conducted of a rapid finger-prick HIV testing upon registration at primary care facilities. That trial took place in Hackney, a poor inner-London borough and one of 74 localities considered to have high HIV prevalence because it has a rate of more than two diagnosed infections per 1,000 adults.
Leber and colleagues found that the rapid testing resulted in a fourfold increase in HIV diagnoses. In their more recent study, they sought to determine whether it would be cost effective, especially in light of budgetary constraints.
A mathematical model factoring in all the costs of HIV testing and treatment showed that the rapid testing in high-prevalence communities would become cost effective after 33 years, the researchers said. That reaches the upper cost-effectiveness threshold set by the U.K.’s National Institute for Health and Care Excellence (NICE).
Specifically, the researchers found that over 40 years, the incremental cost-effectiveness ratios were £22,201 (95% CI, £12,662 - £132,452) per quality-adjusted life year gained, £372,207 (95% CI, £268, 162 - £1,903, 385) per death averted and £628,874 (95% CI, £434,902 - £4,740,724) per HIV transmission averted.
However, they then considered data from a study conducted in Canada showing higher care costs for patients diagnosed with HIV late in the infection. When they included that data, assuming costs remain at least 60% higher due to late diagnosis, the researchers predicted that testing in primary care could become cost effective after 13 to 18 years and even become cost saving.
They estimated that the rollout of testing in all 74 high-HIV prevalence communities would cost about £4 million annually. This figure does not include HIV treatment costs and would fall under the budget for Public Health, whose functions are delegated to local councils, Leber told Infectious Disease News.
HIV treatment costs, meanwhile, are paid by National Health Services, a body providing overall health care services in the U.K.
The researchers said their data can provide a valuable tool for diagnosing HIV early, which improves outcomes throughout the community.
“Our cost-effectiveness analysis is relatively unusual because we are considering a public health intervention involving therapeutic drug use, thus providing both individual-level and population-level benefits,” the wrote. “Early diagnosis of people who are HIV positive has benefits for the individual [by] improving prognosis, reducing inequalities and improving access to effective ART while also benefiting the wider community by reducing onward HIV transmission.”
Although primary care HIV testing is not universally offered in the United States, the CDC in 2006 recommended that all people aged 13 to 64 years be routinely tested for the virus in all health care settings. Health care providers should conduct screening unless the prevalence of undiagnosed HIV among their patients is less than 0.1%. – by Joe Green
Disclosure: Baggaley reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
References:
Baggaley RF, et al. Lancet HIV. 2017;doi:10.1016/S2352-3018(17)30123-6.
CDC. Revised Recommendations for HIV Testing of Adults, Adolescents and Pregnant Women in Health Care Settings. www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm. Accessed Aug. 8, 2017.
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