F Terris-Prestholt1, D Boeras1,2, J J Ong1,3, S Torres-Rueda1, N Cassim4,5, M A S Mbengue6,7, S Mboup6, M Mwau8, E Munemo9, W Nyegenye10, C O Odhiambo11, P Dabula4, P Sandstrom12, M Sarr13, R Simbi9, W Stevens4, J D Tucker1,14, P Vickerman15, A Ciaranello16, R W Peeling1. 1. London School of Hygiene and Tropical Medicine, London, UK. 2. Global Health Impact Group, Atlanta, GA, USA. 3. Central Clinical School, Monash University, Clayton, Vic, Australia. 4. National Health Laboratory Service, National Priority Programmes, Johannesburg, South Africa. 5. Department of Molecular Medicine and Haematology, University of Witwatersrand, Johannesburg, South Africa. 6. Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formations, Dakar, Sénégal. 7. Department of Epidemiology and Biostatistics, University of the Witwatersrand, Johannesburg, South Africa. 8. Kenya Medical Research Institute, Nairobi, Kenya. 9. Ministry of Health and Child Care, National Microbiology Reference Laboratory, Harare Central Hospital, Harare, Zimbabwe. 10. Ministry of Health Uganda, Kampala, Uganda. 11. Kenya Medical Research Institute, Kisumu, Kenya. 12. National HIV & Retrovirology Laboratories, Public Health Agency of Canada, Winnipeg, Canada. 13. Westat, Inc., Rockville, MD, USA. 14. University of North Carolina, Chapel Hill, NC, USA. 15. School of Social and Community Medicine, University of Bristol, Bristol, UK. 16. Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.
Abstract
OBJECTIVES: Scaling up of point-of-care testing (POCT) for early infant diagnosis of HIV (EID) could reduce the large gap in infant testing. However, suboptimal POCT EID could have limited impact and potentially high avoidable costs. This study models the cost-effectiveness of a quality assurance system to address testing performance and screening interruptions, due to, for example, supply stockouts, in Kenya, Senegal, South Africa, Uganda and Zimbabwe, with varying HIV epidemics and different health systems. METHODS: We modelled a quality assurance system-raised EID quality from suboptimal levels: that is, from misdiagnosis rates of 5%, 10% and 20% and EID testing interruptions in months, to uninterrupted optimal performance (98.5% sensitivity, 99.9% specificity). For each country, we estimated the 1-year impact and cost-effectiveness (US$/DALY averted) of improved scenarios in averting missed HIV infections and unneeded HIV treatment costs for false-positive diagnoses. RESULTS: The modelled 1-year costs of a national POCT quality assurance system range from US$ 69 359 in South Africa to US$ 334 341 in Zimbabwe. At the country level, quality assurance systems could potentially avert between 36 and 711 missed infections (i.e. false negatives) per year and unneeded treatment costs between US$ 5808 and US$ 739 030. CONCLUSIONS: The model estimates adding effective quality assurance systems are cost-saving in four of the five countries within the first year. Starting EQA requires an initial investment but will provide a positive return on investment within five years by averting the costs of misdiagnoses and would be even more efficient if implemented across multiple applications of POCT.
OBJECTIVES: Scaling up of point-of-care testing (POCT) for early infant diagnosis of HIV (EID) could reduce the large gap in infant testing. However, suboptimal POCT EID could have limited impact and potentially high avoidable costs. This study models the cost-effectiveness of a quality assurance system to address testing performance and screening interruptions, due to, for example, supply stockouts, in Kenya, Senegal, South Africa, Uganda and Zimbabwe, with varying HIV epidemics and different health systems. METHODS: We modelled a quality assurance system-raised EID quality from suboptimal levels: that is, from misdiagnosis rates of 5%, 10% and 20% and EID testing interruptions in months, to uninterrupted optimal performance (98.5% sensitivity, 99.9% specificity). For each country, we estimated the 1-year impact and cost-effectiveness (US$/DALY averted) of improved scenarios in averting missed HIV infections and unneeded HIV treatment costs for false-positive diagnoses. RESULTS: The modelled 1-year costs of a national POCT quality assurance system range from US$ 69 359 in South Africa to US$ 334 341 in Zimbabwe. At the country level, quality assurance systems could potentially avert between 36 and 711 missed infections (i.e. false negatives) per year and unneeded treatment costs between US$ 5808 and US$ 739 030. CONCLUSIONS: The model estimates adding effective quality assurance systems are cost-saving in four of the five countries within the first year. Starting EQA requires an initial investment but will provide a positive return on investment within five years by averting the costs of misdiagnoses and would be even more efficient if implemented across multiple applications of POCT.
Keywords:
HIV; VIH; cost-effectiveness; diagnostic précoce du nourrisson; dépistage au point des soins; early infant diagnosis; point-of-care testing; programme d'amélioration de la qualité; quality improvement programme; rapport coût-efficacité
Authors: Catherine G Sutcliffe; Nkumbula Moyo; Jessica L Schue; Jane N Mutanga; Mutinta Hamahuwa; Passwell Munachoonga; Sylvia Maunga; Philip E Thuma; William J Moss Journal: Trop Med Int Health Date: 2021-06-07 Impact factor: 3.918
Authors: Kira Elsbernd; Karl M F Emmert-Fees; Amanda Erbe; Veronica Ottobrino; Arne Kroidl; Till Bärnighausen; Benjamin P Geisler; Stefan Kohler Journal: Infect Dis Poverty Date: 2022-07-15 Impact factor: 10.485