Economic and health implications from earlier detection of HIV infection in the United Kingdom

Economic and health implications from earlier detection of HIV infection in the United Kingdom

2016 HIV AIDS (Auckl)

Zah, V. | Toumi, M. | Volume: 8, Issue: , Pages: 67-74, Hiv, costs, model, savings, testing,

PURPOSE: To model the budget and survival impact of implementing interventions to increase the proportion of HIV infections detected early in a given UK population. PATIENTS AND METHODS: A Microsoft Excel decision model was designed to generate a set of outcomes for a defined population. Survival was modeled on the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) study extrapolated to a 5-year horizon as a constant hazard. Hazard rates were specific to age, sex, and whether detection was early or late. The primary outcomes for each year up to 5 years were: annual costs, numbers of infected cases, hospital admissions, and surviving cases. Three locations in the UK were chosen to model outcomes across a range of HIV prevalence areas: Lambeth, Southwark, and Lewisham (LSL), Greater Manchester Cluster (GMC), and Kent and Medway (K&M). RESULTS: In LSL, the projected cumulative cost savings over 5 years were pound3,210,206 or pound5,290,206 when including the value of the 104 life-years saved. Savings were insensitive to transmission rates, but sensitive in direct proportion to the percentage shift from late to early detection. In GMC, savings were in a similar proportion to LSL, but the magnitude was smaller, as a consequence of the lower base-case HIV prevalence. In K&M, with a smaller population and lower HIV prevalence than GMC, savings were commensurately smaller ( pound733,202 cumulatively over 5 years). CONCLUSION: The results strengthen the rationale for implementing increased testing in high prevalence areas. However, in areas of low prevalence, it is unlikely that costs will be returned over a 5-year period.

https://www.doi.org/10.2147/HIV.S96713