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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

1
Hôpital 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.
2
Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal.
3
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.
4
Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
5
Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
6
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 ; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America.
7
Division 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.
8
The 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.
9
Division 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.
10
Department 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
PMCID:
PMC3867470
DOI:
10.1371/journal.pone.0084173
[Indexed for MEDLINE]
Free PMC Article
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