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Cost-effectiveness of community-based HIV self-testing in Blantyre, Malawi
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Maheswaran, Hendramoorthy, Clarke, Aileen, MacPherson, P., Kumwenda, F., Lalloo, D. G., Corbett, E. L. and Petrou, Stavros (2018) Cost-effectiveness of community-based HIV self-testing in Blantyre, Malawi. Clinical Infectious Diseases, 66 (8). pp. 1211-1221. cix983. doi:10.1093/cid/cix983
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Official URL: https://doi.org/10.1093/cid/cix983
Abstract
Background:
Human immunodeficiency virus self-testing (HIVST) is effective, with scale-up underway in sub-Saharan Africa. We assessed cost-effectiveness of adding HIVST to existing facility-based HIV testing and counseling (HTC) services. Both 2010 (initiate at CD4 <350 cells/μL) and 2015 (initiate all) World Health Organization (WHO) guidelines for antiretroviral treatment (ART) were considered.
Methods:
A microsimulation model was developed to evaluate cost-effectiveness, from both health provider and societal perspectives, of an HIVST service implemented in a cluster-randomized trial (CRT; ISRCTN02004005) in Malawi. Costs and health outcomes were evaluated over a 20-year time horizon, using a discount rate of 3%. Probabilistic sensitivity analysis was conducted to account for parameter uncertainty.
Results:
From the health provider perspective and 20-year time horizon, facility HTC using 2010 WHO ART guidelines was the least costly ($294.71 per person; 95% credible interval [CrI], 270.79–318.45) and least effective (11.64 quality-adjusted life-years [QALYs] per person; 95% CrI, 11.43–11.86) strategy. Compared with this strategy, the incremental cost-effectiveness ratio (ICER) for facility HTC using 2015 WHO ART guidelines was $226.85 (95% CrI, 198.79–284.35) per QALY gained. The strategy of facility HTC plus HIVST, using 2010 WHO ART guidelines, was extendedly dominated. The ICER for facility HTC plus HIVST, using 2015 WHO ART guidelines, was $253.90 (95% CrI, 201.71–342.02) per QALY gained compared with facility HTC and using 2015 WHO ART guidelines.
Conclusions:
HIVST may be cost-effective in a Malawian population with high HIV prevalence. HIVST is suited to an early HIV diagnosis and treatment strategy.
| Item Type: | Journal Article | ||||||||||||
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| Subjects: | R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine | ||||||||||||
| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | HIV infections -- Diagnosis -- Cost effectiveness -- Blantyre (Malawi) -- Case studies | ||||||||||||
| Journal or Publication Title: | Clinical Infectious Diseases | ||||||||||||
| Publisher: | Oxford University Press | ||||||||||||
| ISSN: | 1058-4838 | ||||||||||||
| Official Date: | 3 April 2018 | ||||||||||||
| Dates: |
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| Volume: | 66 | ||||||||||||
| Number: | 8 | ||||||||||||
| Page Range: | pp. 1211-1221 | ||||||||||||
| Article Number: | cix983 | ||||||||||||
| DOI: | 10.1093/cid/cix983 | ||||||||||||
| Status: | Peer Reviewed | ||||||||||||
| Publication Status: | Published | ||||||||||||
| Access rights to Published version: | Open Access | ||||||||||||
| RIOXX Funder/Project Grant: |
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