PURPOSE: The US Food and Drug Administration recently approved the first 4th-generation HIV test. This study evaluated the cost-effectiveness of the 4th-generation assay versus a 3rd-generation test in screening for HIV infections in the United States. METHODS: An exploratory microsimulation model was developed that follows hypothetical individuals and simulates the course of HIV/AIDS, treatment with highly active antiretroviral therapy, and transmissions. RESULTS: With a 1% HIV prevalence, screening 1.5 million individuals with the 4th- versus 3rd-generation assay resulted in detection of 266 additional HIV cases at an incremental cost per additional HIV case detected of $63,763, an additional 489 life years and 395 quality-adjusted life years (QALYs), and 26 HIV transmissions prevented. Although lifetime costs were increased by $33.6 million, the incremental cost/QALY gained was $85,206. The 4th-generation test was more cost-effective in high incidence settings. The number needed to screen to detect one additional HIV case was 5,635. CONCLUSIONS: Screening using the 4th-generation assay may be cost-effective for HIV detection in appropriate settings, resulting in increased case identification, fewer transmissions, extended life, and increased quality of life. With early and accurate detection, this 4th-generation test may provide a suitable alternative to current 3rd-generation tests.
PURPOSE: The US Food and Drug Administration recently approved the first 4th-generation HIV test. This study evaluated the cost-effectiveness of the 4th-generation assay versus a 3rd-generation test in screening for HIV infections in the United States. METHODS: An exploratory microsimulation model was developed that follows hypothetical individuals and simulates the course of HIV/AIDS, treatment with highly active antiretroviral therapy, and transmissions. RESULTS: With a 1% HIV prevalence, screening 1.5 million individuals with the 4th- versus 3rd-generation assay resulted in detection of 266 additional HIV cases at an incremental cost per additional HIV case detected of $63,763, an additional 489 life years and 395 quality-adjusted life years (QALYs), and 26 HIV transmissions prevented. Although lifetime costs were increased by $33.6 million, the incremental cost/QALY gained was $85,206. The 4th-generation test was more cost-effective in high incidence settings. The number needed to screen to detect one additional HIV case was 5,635. CONCLUSIONS: Screening using the 4th-generation assay may be cost-effective for HIV detection in appropriate settings, resulting in increased case identification, fewer transmissions, extended life, and increased quality of life. With early and accurate detection, this 4th-generation test may provide a suitable alternative to current 3rd-generation tests.
Authors: Arik V Marcell; Lauren Okano; Nanlesta A Pilgrim; Jacky M Jennings; Kathleen R Page; Renata Sanders; Penny S Loosier; Patricia J Dittus Journal: Public Health Rep Date: 2017-01-25 Impact factor: 2.792
Authors: Eleanor R Gray; Robert Bain; Olivia Varsaneux; Rosanna W Peeling; Molly M Stevens; Rachel A McKendry Journal: AIDS Date: 2018-09-24 Impact factor: 4.177
Authors: Sarah E Rutstein; Audrey E Pettifor; Sam Phiri; Gift Kamanga; Irving F Hoffman; Mina C Hosseinipour; Nora E Rosenberg; Dominic Nsona; Dana Pasquale; Gerald Tegha; Kimberly A Powers; Mcleod Phiri; Bisweck Tembo; Wairimu Chege; William C Miller Journal: J Acquir Immune Defic Syndr Date: 2016-03-01 Impact factor: 3.731
Authors: Sarah E Rutstein; Jintanat Ananworanich; Sarah Fidler; Cheryl Johnson; Eduard J Sanders; Omar Sued; Asier Saez-Cirion; Christopher D Pilcher; Christophe Fraser; Myron S Cohen; Marco Vitoria; Meg Doherty; Joseph D Tucker Journal: J Int AIDS Soc Date: 2017-06-28 Impact factor: 5.396