Cost effectiveness of screening strategies for early identification of HIV and HCV infection in injection drug users.

<h4>Objective</h4>To estimate the cost, effectiveness, and cost effectiveness of HIV and HCV screening of injection drug users (IDUs) in opioid replacement therapy (ORT).<h4>Design</h4>Dynamic compartmental model of HIV and HCV in a population of IDUs and non-IDUs for a repre...

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Autores principales:	Lauren E Cipriano, Gregory S Zaric, Mark Holodniy, Eran Bendavid, Douglas K Owens, Margaret L Brandeau
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/1bcc6d4ef83c46b4835679a04a3cf003
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spelling	oai:doaj.org-article:1bcc6d4ef83c46b4835679a04a3cf0032021-11-18T07:05:11ZCost effectiveness of screening strategies for early identification of HIV and HCV infection in injection drug users.1932-620310.1371/journal.pone.0045176https://doaj.org/article/1bcc6d4ef83c46b4835679a04a3cf0032012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23028828/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Objective</h4>To estimate the cost, effectiveness, and cost effectiveness of HIV and HCV screening of injection drug users (IDUs) in opioid replacement therapy (ORT).<h4>Design</h4>Dynamic compartmental model of HIV and HCV in a population of IDUs and non-IDUs for a representative U.S. urban center with 2.5 million adults (age 15-59).<h4>Methods</h4>We considered strategies of screening individuals in ORT for HIV, HCV, or both infections by antibody or antibody and viral RNA testing. We evaluated one-time and repeat screening at intervals from annually to once every 3 months. We calculated the number of HIV and HCV infections, quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs).<h4>Results</h4>Adding HIV and HCV viral RNA testing to antibody testing averts 14.8-30.3 HIV and 3.7-7.7 HCV infections in a screened population of 26,100 IDUs entering ORT over 20 years, depending on screening frequency. Screening for HIV antibodies every 6 months costs $30,700/QALY gained. Screening for HIV antibodies and viral RNA every 6 months has an ICER of $65,900/QALY gained. Strategies including HCV testing have ICERs exceeding $100,000/QALY gained unless awareness of HCV-infection status results in a substantial reduction in needle-sharing behavior.<h4>Discussion</h4>Although annual screening for antibodies to HIV and HCV is modestly cost effective compared to no screening, more frequent screening for HIV provides additional benefit at less cost. Screening individuals in ORT every 3-6 months for HIV infection using both antibody and viral RNA technologies and initiating ART for acute HIV infection appears cost effective.Lauren E CiprianoGregory S ZaricMark HolodniyEran BendavidDouglas K OwensMargaret L BrandeauPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 9, p e45176 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Lauren E Cipriano Gregory S Zaric Mark Holodniy Eran Bendavid Douglas K Owens Margaret L Brandeau Cost effectiveness of screening strategies for early identification of HIV and HCV infection in injection drug users.
description	<h4>Objective</h4>To estimate the cost, effectiveness, and cost effectiveness of HIV and HCV screening of injection drug users (IDUs) in opioid replacement therapy (ORT).<h4>Design</h4>Dynamic compartmental model of HIV and HCV in a population of IDUs and non-IDUs for a representative U.S. urban center with 2.5 million adults (age 15-59).<h4>Methods</h4>We considered strategies of screening individuals in ORT for HIV, HCV, or both infections by antibody or antibody and viral RNA testing. We evaluated one-time and repeat screening at intervals from annually to once every 3 months. We calculated the number of HIV and HCV infections, quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs).<h4>Results</h4>Adding HIV and HCV viral RNA testing to antibody testing averts 14.8-30.3 HIV and 3.7-7.7 HCV infections in a screened population of 26,100 IDUs entering ORT over 20 years, depending on screening frequency. Screening for HIV antibodies every 6 months costs $30,700/QALY gained. Screening for HIV antibodies and viral RNA every 6 months has an ICER of $65,900/QALY gained. Strategies including HCV testing have ICERs exceeding $100,000/QALY gained unless awareness of HCV-infection status results in a substantial reduction in needle-sharing behavior.<h4>Discussion</h4>Although annual screening for antibodies to HIV and HCV is modestly cost effective compared to no screening, more frequent screening for HIV provides additional benefit at less cost. Screening individuals in ORT every 3-6 months for HIV infection using both antibody and viral RNA technologies and initiating ART for acute HIV infection appears cost effective.
format	article
author	Lauren E Cipriano Gregory S Zaric Mark Holodniy Eran Bendavid Douglas K Owens Margaret L Brandeau
author_facet	Lauren E Cipriano Gregory S Zaric Mark Holodniy Eran Bendavid Douglas K Owens Margaret L Brandeau
author_sort	Lauren E Cipriano
title	Cost effectiveness of screening strategies for early identification of HIV and HCV infection in injection drug users.
title_short	Cost effectiveness of screening strategies for early identification of HIV and HCV infection in injection drug users.
title_full	Cost effectiveness of screening strategies for early identification of HIV and HCV infection in injection drug users.
title_fullStr	Cost effectiveness of screening strategies for early identification of HIV and HCV infection in injection drug users.
title_full_unstemmed	Cost effectiveness of screening strategies for early identification of HIV and HCV infection in injection drug users.
title_sort	cost effectiveness of screening strategies for early identification of hiv and hcv infection in injection drug users.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/1bcc6d4ef83c46b4835679a04a3cf003
work_keys_str_mv	AT laurenecipriano costeffectivenessofscreeningstrategiesforearlyidentificationofhivandhcvinfectionininjectiondrugusers AT gregoryszaric costeffectivenessofscreeningstrategiesforearlyidentificationofhivandhcvinfectionininjectiondrugusers AT markholodniy costeffectivenessofscreeningstrategiesforearlyidentificationofhivandhcvinfectionininjectiondrugusers AT eranbendavid costeffectivenessofscreeningstrategiesforearlyidentificationofhivandhcvinfectionininjectiondrugusers AT douglaskowens costeffectivenessofscreeningstrategiesforearlyidentificationofhivandhcvinfectionininjectiondrugusers AT margaretlbrandeau costeffectivenessofscreeningstrategiesforearlyidentificationofhivandhcvinfectionininjectiondrugusers
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Cost effectiveness of screening strategies for early identification of HIV and HCV infection in injection drug users.

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