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PLoS One. 2013 Dec 18;8(12):e84173. doi: 10.1371/journal.pone.0084173. eCollection 2013.

Routine HIV screening in Portugal: clinical impact and cost-effectiveness.

Author information

  • 1Hôpital Bichat, Université Paris Diderot, Paris, France ; ATIP-Avenir Inserm: "Modélisation, Aide à la Décision, et Coût-Efficacité en Maladies Infectieuses," Inserm U1137, Université Denis Diderot, Paris, France.
  • 2Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal.
  • 3Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
  • 4Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
  • 5Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
  • 6Harvard Medical School, Boston, Massachusetts, United States of America ; Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Brigham and Women's Hospital, Boston, Massachusetts, United States of America ; Harvard Center for AIDS Research, Boston, Massachusetts, United States of America ; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America.
  • 7Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Harvard Medical School, Boston, Massachusetts, United States of America ; Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Brigham and Women's Hospital, Boston, Massachusetts, United States of America ; Harvard Center for AIDS Research, Boston, Massachusetts, United States of America.
  • 8The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, United States of America ; Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts, United States of America.
  • 9Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Harvard Medical School, Boston, Massachusetts, United States of America ; Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America ; Harvard Center for AIDS Research, Boston, Massachusetts, United States of America ; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America.
  • 10Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, United States of America.

Abstract

OBJECTIVE:

To compare the clinical outcomes and cost-effectiveness of routine HIV screening in Portugal to the current practice of targeted and on-demand screening.

DESIGN:

We used Portuguese national clinical and economic data to conduct a model-based assessment.

METHODS:

We compared current HIV detection practices to strategies of increasingly frequent routine HIV screening in Portuguese adults aged 18-69. We considered several subpopulations and geographic regions with varying levels of undetected HIV prevalence and incidence. Baseline inputs for the national case included undiagnosed HIV prevalence 0.16%, annual incidence 0.03%, mean population age 43 years, mean CD4 count at care initiation 292 cells/μL, 63% HIV test acceptance, 78% linkage to care, and HIV rapid test cost €6 under the proposed routine screening program. Outcomes included quality-adjusted survival, secondary HIV transmission, cost, and incremental cost-effectiveness.

RESULTS:

One-time national HIV screening increased HIV-infected survival from 164.09 quality-adjusted life months (QALMs) to 166.83 QALMs compared to current practice and had an incremental cost-effectiveness ratio (ICER) of €28,000 per quality-adjusted life year (QALY). Screening more frequently in higher-risk groups was cost-effective: for example screening annually in men who have sex with men or screening every three years in regions with higher incidence and prevalence produced ICERs of €21,000/QALY and €34,000/QALY, respectively.

CONCLUSIONS:

One-time HIV screening in the Portuguese national population will increase survival and is cost-effective by international standards. More frequent screening in higher-risk regions and subpopulations is also justified. Given Portugal's challenging economic priorities, we recommend prioritizing screening in higher-risk populations and geographic settings.

PMID:
24367639
[PubMed - indexed for MEDLINE]
PMCID:
PMC3867470
Free PMC Article
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