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

Research output: Contribution to journalJournal article

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  • Yazdan Yazdanpanah
  • Julian Perelman
  • Madeline A. DiLorenzo
  • Joana Alves
  • Henrique Barros
  • Ceu Mateus
  • João Pereira
  • Kamal Mansinho
  • Marion Robine
  • Ji-Eun Park
  • Eric L. Ross
  • Elena Losina
  • Rochelle P. Walensky
  • Farzad Noubary
  • Kenneth A. Freedberg
  • A. David Paltiel
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Article numbere84173
<mark>Journal publication date</mark>18/12/2013
<mark>Journal</mark>PLoS ONE
Issue number12
Volume8
Number of pages11
Publication statusPublished
Original languageEnglish

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.