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AIDS. 2019 Mar 15. doi: 10.1097/QAD.0000000000002199. [Epub ahead of print]

Cost-effectiveness of increased hiv testing among men who have sex with men in the netherlands.

Author information

1
Department of Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
2
Radboud University Medical Center, Nijmegen, The Netherlands.
3
Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands.
4
Department of Internal Medicine, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centre, University of Amsterdam, The Netherlands.
5
Stichting HIV Monitoring, Amsterdam, The Netherlands.
6
Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands.

Abstract

OBJECTIVES:

To assess the cost-effectiveness of increased consistent HIV testing among men who have sex with men (MSM) in the Netherlands.

METHODS:

Among MSM testing at STI clinics in the Netherlands in 2014-2015, approximately 20% tested consistently every six months. We examined four scenarios with increased percentage of MSM testing every six months: a small and a moderate increase among all MSM; a small and a moderate increase only among MSM with ≥10 partners in the preceding six months. We used an agent-based model to calculate numbers of HIV infections and AIDS cases prevented with increased HIV testing. These numbers were used in an economic model to calculate costs, quality-adjusted life-years (QALY), and incremental cost-effectiveness ratios (ICER) due to increased testing, over 2018-2027, taking a healthcare payer perspective.

RESULTS:

A small increase in the percentage testing every six months among all MSM resulted in 490 averted HIV infections and an average ICER of &OV0556;27,900/QALY gained. A moderate increase among all MSM, resulted in 1380 averted HIV infections and an average ICER of &OV0556;36,700/QALY gained. Both were not cost-effective, with a &OV0556;20,000 willingness-to-pay threshold. Increasing the percentage testing every six months only among MSM with ≥10 partners in the preceding six months resulted in less averted HIV infections than increased testing among all MSM, but was on average cost-saving.

CONCLUSIONS:

Increased HIV testing can prevent considerable numbers of new HIV infections among MSM, but may be cost-effective only if targeted at high-risk individuals, such as those with many partners.

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