Cost-per-diagnosis as a metric for monitoring cost-effectiveness of HIV testing programmes in low-income settings in southern Africa : health economic and modelling analysis

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dc.contributor.authorPhillips, Andrew N.en_ZA
dc.contributor.authorCambiano, Valentinaen_ZA
dc.contributor.authorNakagawa, Fumiyoen_ZA
dc.contributor.authorBansi-Matharu, Loveleenen_ZA
dc.contributor.authorWilson, Daviden_ZA
dc.contributor.authorJani, Ileshen_ZA
dc.contributor.authorApollo, Tsitsien_ZA
dc.contributor.authorSculpher, Marken_ZA
dc.contributor.authorHallett, Timothyen_ZA
dc.contributor.authorKerr, Cliffen_ZA
dc.contributor.authorVan Oosterhout, J.en_ZA
dc.contributor.authorEaton, Jeffrey W.en_ZA
dc.contributor.authorEstill, Janneen_ZA
dc.contributor.authorWilliams, Brianen_ZA
dc.contributor.authorDoi, Naokoen_ZA
dc.contributor.authorCowan, Francesen_ZA
dc.contributor.authorKeiser, Oliviaen_ZA
dc.contributor.authorFord, Deborahen_ZA
dc.contributor.authorHatzold, Karinen_ZA
dc.contributor.authorBarnabas, Ruanneen_ZA
dc.contributor.authorAyles, Helenen_ZA
dc.contributor.authorMeyer-Rath, Gesineen_ZA
dc.contributor.authorNelson, Lisaen_ZA
dc.contributor.authorJohnson, Cherylen_ZA
dc.contributor.authorBaggaley, Rachelen_ZA
dc.contributor.authorFakoya, Adeen_ZA
dc.contributor.authorJahn, Andreasen_ZA
dc.contributor.authorRevill, Paulen_ZA
dc.date.accessioned2021-10-14T09:55:56Z
dc.date.available2021-10-14T09:55:56Z
dc.date.issued2019
dc.descriptionCITATION: Phillips, A. N., et al. 2019. Cost-per-diagnosis as a metric for monitoring cost-effectiveness of HIV testing programmes in low-income settings in southern Africa : health economic and modelling analysis. Journal of the International AIDS Society, 22(7):e25325, doi:10.1002/jia2.25325.
dc.descriptionThe original publication is available at https://onlinelibrary.wiley.com/
dc.description.abstractIntroduction: As prevalence of undiagnosed HIV declines, it is unclear whether testing programmes will be cost-effective. To guide their HIV testing programmes, countries require appropriate metrics that can be measured. The cost-per-diagnosis is potentially a useful metric. Methods: We simulated a series of setting-scenarios for adult HIV epidemics and ART programmes typical of settings in southern Africa using an individual-based model and projected forward from 2018 under two policies: (i) a minimum package of “core” testing (i.e. testing in pregnant women, for diagnosis of symptoms, in sex workers, and in men coming forward for circumcision) is conducted, and (ii) core-testing as above plus additional testing beyond this (“additionaltesting”), for which we specify different rates of testing and various degrees to which those with HIV are more likely to test than those without HIV. We also considered a plausible range of unit test costs. The aim was to assess the relationship between cost-per-diagnosis and the incremental cost-effectiveness ratio (ICER) of the additional-testing policy. The discount rate used in the base case was 3% per annum (costs in 2018 U.S. dollars). Results: There was a strong graded relationship between the cost-per-diagnosis and the ICER. Overall, the ICER was below $500 per-DALY-averted (the cost-effectiveness threshold used in primary analysis) so long as the cost-per-diagnosis was below $315. This threshold cost-per-diagnosis was similar according to epidemic and programmatic features including the prevalence of undiagnosed HIV, the HIV incidence and a measure of HIV programme quality (the proportion of HIV diagnosed people having a viral load <1000 copies/mL). However, restricting to women, additional-testing did not appear cost-effective even at a cost-per-diagnosis of below $50, while restricting to men additional-testing was cost-effective up to a cost-per-diagnosis of $585. The threshold cost per diagnosis for testing in men to be cost-effective fell to $256 when the cost-effectiveness threshold was $300 instead of $500, and to $81 when considering a discount rate of 10% per annum. Conclusions: For testing programmes in low-income settings in southern African there is an extremely strong relationship between the cost-per-diagnosis and the cost-per-DALY averted, indicating that the cost-per-diagnosis can be used to monitor the cost-effectiveness of testing programmes.en_ZA
dc.description.urihttps://onlinelibrary.wiley.com/doi/10.1002/jia2.25325
dc.description.versionPublisher’s version
dc.format.extent10 pages
dc.identifier.citationPhillips, A. N., et al. 2019. Cost-per-diagnosis as a metric for monitoring cost-effectiveness of HIV testing programmes in low-income settings in southern Africa : health economic and modelling analysis. Journal of the International AIDS Society, 22(7):e25325, doi:10.1002/jia2.25325
dc.identifier.issn1758-2652 (online)
dc.identifier.otherdoi:10.1002/jia2.25325
dc.identifier.urihttp://hdl.handle.net/10019.1/123227
dc.language.isoen_ZAen_ZA
dc.publisherInternational AIDS Society
dc.rights.holderAuthors retain rights
dc.subjectHIV infections -- Testing -- Cost effectivenessen_ZA
dc.subjectHIV infections -- Prevention -- Cost effectivenessen_ZA
dc.subjectHIV infections -- Africa, Southernen_ZA
dc.titleCost-per-diagnosis as a metric for monitoring cost-effectiveness of HIV testing programmes in low-income settings in southern Africa : health economic and modelling analysisen_ZA
dc.typeArticleen_ZA
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