Martin Hoenigl1, Antoine Chaillon2, Sanjay R Mehta3, Davey M Smith3, Joshua Graff-Zivin4, Susan J Little2. 1. Division of Infectious Diseases, University of California San Diego (UCSD), 220 Dickinson Street, Suite A, San Diego, CA 92103, United States; Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 20, 8036 Graz, Austria; Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria. Electronic address: mhoenigl@ucsd.edu. 2. Division of Infectious Diseases, University of California San Diego (UCSD), 220 Dickinson Street, Suite A, San Diego, CA 92103, United States. 3. Division of Infectious Diseases, University of California San Diego (UCSD), 220 Dickinson Street, Suite A, San Diego, CA 92103, United States; Veterans Affairs Healthcare System, 3350 La Jolla Village Drive, San Diego, CA 92161, United States. 4. School of International Relations and Pacific Studies, Department of Economics, UCSD, 9500 Gilman Dr. # 0520, La Jolla, CA 92093, United States.
Abstract
OBJECTIVES: To determine cost-effectiveness of three community-based acute HIV infection (AHI) testing algorithms compared to HIV antibody testing alone by focusing on the potential of averting new infections occurring within a one-year time horizon among men who have sex with men (MSM). METHODS: Data sources for model parameters included actual cost and prevalence data derived from a community-based AHI screening program in San Diego, and published studies. Main outcome measure was costs per infection averted (IA). The lower end of the cost range of discounted lifetime costs of an HIV infection (i.e. $236,948) was used for defining cost-effectiveness. RESULTS: The most sensitive algorithm for AHI detection, which was based on HIV nucleic acid amplification testing, was estimated to prevent between 5 and 45 transmissions, with simulated costs per infection averted between $965 and $141,256 when compared to HIV antibody testing alone. CONCLUSION: AHI testing was cost-effective in preventing new HIV infections among at risk MSM in San Diego, and also among other MSM populations with similar HIV prevalence but lower proportions of AHI diagnoses. These results indicate that community-based AHI testing among MSM in the United States can pay for itself over the long run.
OBJECTIVES: To determine cost-effectiveness of three community-based acute HIV infection (AHI) testing algorithms compared to HIV antibody testing alone by focusing on the potential of averting new infections occurring within a one-year time horizon among men who have sex with men (MSM). METHODS: Data sources for model parameters included actual cost and prevalence data derived from a community-based AHI screening program in San Diego, and published studies. Main outcome measure was costs per infection averted (IA). The lower end of the cost range of discounted lifetime costs of an HIV infection (i.e. $236,948) was used for defining cost-effectiveness. RESULTS: The most sensitive algorithm for AHI detection, which was based on HIV nucleic acid amplification testing, was estimated to prevent between 5 and 45 transmissions, with simulated costs per infection averted between $965 and $141,256 when compared to HIV antibody testing alone. CONCLUSION: AHI testing was cost-effective in preventing new HIV infections among at risk MSM in San Diego, and also among other MSM populations with similar HIV prevalence but lower proportions of AHI diagnoses. These results indicate that community-based AHI testing among MSM in the United States can pay for itself over the long run.
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