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- Title
Routine HIV Screening in France: Clinical Impact and Cost-Effectiveness.
- Authors
Yazdanpanah, Yazdan; Sloan, Caroline E.; Charlois-Ou, Cécile; Le Vu, Stéphane; Semaille, Caroline; Costagliola, Dominique; Pillonel, Josiane; Poullié, Anne-Isabelle; Scemama, Olivier; Deuffic-Burban, Sylvie; Losina, Elena; Walensky, Rochelle P.; Freedberg, Kenneth A.; Paltiel, A. David
- Abstract
Background: In France, roughly 40,000 HIV-infected persons are unaware of their HIV infection. Although previous studies have evaluated the cost-effectiveness of routine HIV screening in the United States, differences in both the epidemiology of infection and HIV testing behaviors warrant a setting-specific analysis for France. Methods/Principal Findings: We estimated the life expectancy (LE), cost and cost-effectiveness of alternative HIV screening strategies in the French general population and high-risk sub-populations using a computer model of HIV detection and treatment, coupled with French national clinical and economic data. We compared risk-factor-based HIV testing (''current practice'') to universal routine, voluntary HIV screening in adults aged 18-69. Screening frequencies ranged from once to annually. Input data included mean age (42 years), undiagnosed HIV prevalence (0.10%), annual HIV incidence (0.01%), test acceptance (79%), linkage to care (75%) and cost/test (€43). We performed sensitivity analyses on HIV prevalence and incidence, cost estimates, and the transmission benefits of ART. ''Current practice'' produced LEs of 242.82 quality-adjusted life months (QALM) among HIV-infected persons and 268.77 QALM in the general population. Adding a one-time HIV screen increased LE by 0.01 QALM in the general population and increased costs by €50/person, for a cost-effectiveness ratio (CER) of €57,400 per quality-adjusted life year (QALY). More frequent screening in the general population increased survival, costs and CERs. Among injection drug users (prevalence 6.17%; incidence 0.17%/year) and in French Guyana (prevalence 0.41%; incidence 0.35%/year), annual screening compared to every five years produced CERs of €51,200 and €6,500/QALY. Conclusions/Significance: One-time routine HIV screening in France improves survival compared to ''current practice'' and compares favorably to other screening interventions recommended in Western Europe. In higher-risk groups, more frequent screening is economically justifiable.
- Subjects
FRANCE; DIAGNOSIS of HIV infections; HIV-positive persons; LIFE expectancy; COST effectiveness; EPIDEMIOLOGY; PUBLIC health; DISEASE prevalence; DISEASE incidence
- Publication
PLoS ONE, 2010, Vol 5, Issue 10, p1
- ISSN
1932-6203
- Publication type
Article
- DOI
10.1371/journal.pone.0013132