Bohdan Nosyk1,2, Jeong E Min1, Emanuel Krebs1, Xiao Zang1, Miranda Compton3, Reka Gustafson3, Rolando Barrios1,3, Julio S G Montaner1,4. 1. BC Centre for Excellence in HIV/AIDS, Vancouver. 2. Faculty of Health Sciences, Simon Fraser University, Burnaby. 3. Vancouver Coastal Health Authority, University of British Columbia, Vancouver, British Columbia, Canada. 4. Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Abstract
Background: Recognition of the secondary preventive benefits of antiretroviral therapy (ART) has mobilized global efforts to "seek, test, treat, and retain" people living with human immunodeficiency virus [HIV]/AIDS (PLHIV) in HIV care. We aimed to determine the cost-effectiveness of a set of HIV testing and treatment engagement interventions initiated in British Columbia, Canada, in 2011-2013. Methods: Using a previously validated dynamic HIV transmission model, linked individual-level health administrative data for PLHIV, and aggregate-level HIV testing data, we estimated the cost-effectiveness of primary care testing (hospital, emergency department [ED], outpatient), ART initiation, and ART retention initiatives vs a counterfactual scenario that approximated the status quo. HIV incidence, mortality, costs (in 2015$CDN), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios were estimated. Analyses were executed over 5- to 25-year time horizons from a government-payer perspective. Results: ED testing was the best value at $30216 per QALY gained and had the greatest impact on incidence and mortality among PLHIV, while ART initiation provided the greatest QALY gains. The ART retention initiative was not cost-effective. Delivered in combination at the observed scale and sustained throughout the study period, we estimated a 12.8% reduction in cumulative HIV incidence and a 4.7% reduction in deaths among PLHIV at $55258 per QALY gained. Results were most sensitive to uncertainty in the number of undiagnosed PLHIV. Conclusions: HIV testing and ART initiation interventions were cost-effective, while the ART retention intervention was not. Developing strategies to reengage PLHIV lost to care is a priority moving forward.
Background: Recognition of the secondary preventive benefits of antiretroviral therapy (ART) has mobilized global efforts to "seek, test, treat, and retain" people living with human immunodeficiency virus [HIV]/AIDS (PLHIV) in HIV care. We aimed to determine the cost-effectiveness of a set of HIV testing and treatment engagement interventions initiated in British Columbia, Canada, in 2011-2013. Methods: Using a previously validated dynamic HIV transmission model, linked individual-level health administrative data for PLHIV, and aggregate-level HIV testing data, we estimated the cost-effectiveness of primary care testing (hospital, emergency department [ED], outpatient), ART initiation, and ART retention initiatives vs a counterfactual scenario that approximated the status quo. HIV incidence, mortality, costs (in 2015$CDN), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios were estimated. Analyses were executed over 5- to 25-year time horizons from a government-payer perspective. Results: ED testing was the best value at $30216 per QALY gained and had the greatest impact on incidence and mortality among PLHIV, while ART initiation provided the greatest QALY gains. The ART retention initiative was not cost-effective. Delivered in combination at the observed scale and sustained throughout the study period, we estimated a 12.8% reduction in cumulative HIV incidence and a 4.7% reduction in deaths among PLHIV at $55258 per QALY gained. Results were most sensitive to uncertainty in the number of undiagnosed PLHIV. Conclusions: HIV testing and ART initiation interventions were cost-effective, while the ART retention intervention was not. Developing strategies to reengage PLHIV lost to care is a priority moving forward.
Authors: M L Kamb; M Fishbein; J M Douglas; F Rhodes; J Rogers; G Bolan; J Zenilman; T Hoxworth; C K Malotte; M Iatesta; C Kent; A Lentz; S Graziano; R H Byers; T A Peterman Journal: JAMA Date: 1998-10-07 Impact factor: 56.272
Authors: Xiao Zang; Emanuel Krebs; Linwei Wang; Brandon D L Marshall; Reuben Granich; Bruce R Schackman; Julio S G Montaner; Bohdan Nosyk Journal: Pharmacoeconomics Date: 2019-10 Impact factor: 4.981
Authors: Xiao Zang; Emanuel Krebs; Jeong E Min; Ankur Pandya; Brandon D L Marshall; Bruce R Schackman; Czarina N Behrends; Daniel J Feaster; Bohdan Nosyk Journal: Med Decis Making Date: 2019-12-22 Impact factor: 2.583
Authors: Linwei Wang; Jeong Eun Min; Xiao Zang; Paul Sereda; Richard P Harrigan; Julio S G Montaner; Bohdan Nosyk Journal: Clin Infect Dis Date: 2017-10-16 Impact factor: 9.079
Authors: Emanuel Krebs; Benjamin Enns; Linwei Wang; Xiao Zang; Dimitra Panagiotoglou; Carlos Del Rio; Julia Dombrowski; Daniel J Feaster; Matthew Golden; Reuben Granich; Brandon Marshall; Shruti H Mehta; Lisa Metsch; Bruce R Schackman; Steffanie A Strathdee; Bohdan Nosyk Journal: PLoS One Date: 2019-05-30 Impact factor: 3.240
Authors: Bohdan Nosyk; Jeong Eun Min; Xiao Zang; Daniel J Feaster; Lisa Metsch; Brandon D L Marshall; Carlos Del Rio; Reuben Granich; Bruce R Schackman; Julio S G Montaner Journal: J Int Assoc Provid AIDS Care Date: 2019 Jan-Dec