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

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Routine HIV screening in Portugal: clinical impact and cost-effectiveness. / Yazdanpanah, Yazdan; Perelman, Julian; DiLorenzo, Madeline A. et al.
In: PLoS ONE, Vol. 8, No. 12, e84173, 18.12.2013.

Research output: Contribution to Journal/Magazine › Journal article › peer-review

Harvard

Yazdanpanah, Y, Perelman, J, DiLorenzo, MA, Alves, J, Barros, H, Mateus, C, Pereira, J, Mansinho, K, Robine, M, Park, J-E, Ross, EL, Losina, E, Walensky, RP, Noubary, F, Freedberg, KA & Paltiel, AD 2013, 'Routine HIV screening in Portugal: clinical impact and cost-effectiveness', PLoS ONE, vol. 8, no. 12, e84173. https://doi.org/10.1371/journal.pone.0084173

APA

Yazdanpanah, Y., Perelman, J., DiLorenzo, M. A., Alves, J., Barros, H., Mateus, C., Pereira, J., Mansinho, K., Robine, M., Park, J-E., Ross, E. L., Losina, E., Walensky, R. P., Noubary, F., Freedberg, K. A., & Paltiel, A. D. (2013). Routine HIV screening in Portugal: clinical impact and cost-effectiveness. PLoS ONE, 8(12), Article e84173. https://doi.org/10.1371/journal.pone.0084173

Vancouver

Yazdanpanah Y, Perelman J, DiLorenzo MA, Alves J, Barros H, Mateus C et al. Routine HIV screening in Portugal: clinical impact and cost-effectiveness. PLoS ONE. 2013 Dec 18;8(12):e84173. doi: 10.1371/journal.pone.0084173

Author

Yazdanpanah, Yazdan ; Perelman, Julian ; DiLorenzo, Madeline A. et al. / Routine HIV screening in Portugal : clinical impact and cost-effectiveness. In: PLoS ONE. 2013 ; Vol. 8, No. 12.

Bibtex

@article{fddecb96ee064788b1d82e440d784535,
title = "Routine HIV screening in Portugal: clinical impact and cost-effectiveness",
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.",
keywords = "Adolescent, Adult, Aged, Cost-Benefit Analysis, Female, HIV Infections, Humans, Male, Mass Screening, Middle Aged, Portugal, Prevalence, Risk, Young Adult",
author = "Yazdan Yazdanpanah and Julian Perelman and DiLorenzo, {Madeline A.} and Joana Alves and Henrique Barros and Ceu Mateus and Jo{\~a}o Pereira and Kamal Mansinho and Marion Robine and Ji-Eun Park and Ross, {Eric L.} and Elena Losina and Walensky, {Rochelle P.} and Farzad Noubary and Freedberg, {Kenneth A.} and Paltiel, {A. David}",
year = "2013",
month = dec,
day = "18",
doi = "10.1371/journal.pone.0084173",
language = "English",
volume = "8",
journal = "PLoS ONE",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "12",

}

RIS

TY - JOUR

T1 - Routine HIV screening in Portugal

T2 - clinical impact and cost-effectiveness

AU - Yazdanpanah, Yazdan

AU - Perelman, Julian

AU - DiLorenzo, Madeline A.

AU - Alves, Joana

AU - Barros, Henrique

AU - Mateus, Ceu

AU - Pereira, João

AU - Mansinho, Kamal

AU - Robine, Marion

AU - Park, Ji-Eun

AU - Ross, Eric L.

AU - Losina, Elena

AU - Walensky, Rochelle P.

AU - Noubary, Farzad

AU - Freedberg, Kenneth A.

AU - Paltiel, A. David

PY - 2013/12/18

Y1 - 2013/12/18

N2 - 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.

AB - 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.

KW - Adolescent

KW - Adult

KW - Aged

KW - Cost-Benefit Analysis

KW - Female

KW - HIV Infections

KW - Humans

KW - Male

KW - Mass Screening

KW - Middle Aged

KW - Portugal

KW - Prevalence

KW - Risk

KW - Young Adult

U2 - 10.1371/journal.pone.0084173

DO - 10.1371/journal.pone.0084173

M3 - Journal article

C2 - 24367639

VL - 8

JO - PLoS ONE

JF - PLoS ONE

SN - 1932-6203

IS - 12

M1 - e84173

ER -