Cost-effectiveness of HIV screening in STD clinics, emergency departments, and inpatient units: a model-based analysis.

<h4>Background</h4>Identifying and treating persons with human immunodeficiency virus (HIV) infection early in their disease stage is considered an effective means of reducing the impact of the disease. We compared the cost-effectiveness of HIV screening in three settings, sexually trans...

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Autores principales:	Vimalanand S Prabhu, Paul G Farnham, Angela B Hutchinson, Sada Soorapanth, James D Heffelfinger, Matthew R Golden, John T Brooks, David Rimland, Stephanie L Sansom
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2011
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f2d6c6b591f04e77a3ef368d16f9caf3
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spelling	oai:doaj.org-article:f2d6c6b591f04e77a3ef368d16f9caf32021-12-02T20:11:46ZCost-effectiveness of HIV screening in STD clinics, emergency departments, and inpatient units: a model-based analysis.1932-620310.1371/journal.pone.0019936https://doaj.org/article/f2d6c6b591f04e77a3ef368d16f9caf32011-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21625489/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Identifying and treating persons with human immunodeficiency virus (HIV) infection early in their disease stage is considered an effective means of reducing the impact of the disease. We compared the cost-effectiveness of HIV screening in three settings, sexually transmitted disease (STD) clinics serving men who have sex with men, hospital emergency departments (EDs), settings where patients are likely to be diagnosed early, and inpatient diagnosis based on clinical manifestations.<h4>Methods and findings</h4>We developed the Progression and Transmission of HIV/AIDS model, a health state transition model that tracks index patients and their infected partners from HIV infection to death. We used program characteristics for each setting to compare the incremental cost per quality-adjusted life year gained from early versus late diagnosis and treatment. We ran the model for 10,000 index patients for each setting, examining alternative scenarios, excluding and including transmission to partners, and assuming HAART was initiated at a CD4 count of either 350 or 500 cells/µL. Screening in STD clinics and EDs was cost-effective compared with diagnosing inpatients, even when including only the benefits to the index patients. Screening patients in STD clinics, who have less-advanced disease, was cost-effective compared with ED screening when treatment with HAART was initiated at a CD4 count of 500 cells/µL. When the benefits of reduced transmission to partners from early diagnosis were included, screening in settings with less-advanced disease stages was cost-saving compared with screening later in the course of infection. The study was limited by a small number of observations on CD4 count at diagnosis and by including transmission only to first generation partners of the index patients.<h4>Conclusions</h4>HIV prevention efforts can be advanced by screening in settings where patients present with less-advanced stages of HIV infection and by initiating treatment with HAART earlier in the course of infection.Vimalanand S PrabhuPaul G FarnhamAngela B HutchinsonSada SoorapanthJames D HeffelfingerMatthew R GoldenJohn T BrooksDavid RimlandStephanie L SansomPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 6, Iss 5, p e19936 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Vimalanand S Prabhu Paul G Farnham Angela B Hutchinson Sada Soorapanth James D Heffelfinger Matthew R Golden John T Brooks David Rimland Stephanie L Sansom Cost-effectiveness of HIV screening in STD clinics, emergency departments, and inpatient units: a model-based analysis.
description	<h4>Background</h4>Identifying and treating persons with human immunodeficiency virus (HIV) infection early in their disease stage is considered an effective means of reducing the impact of the disease. We compared the cost-effectiveness of HIV screening in three settings, sexually transmitted disease (STD) clinics serving men who have sex with men, hospital emergency departments (EDs), settings where patients are likely to be diagnosed early, and inpatient diagnosis based on clinical manifestations.<h4>Methods and findings</h4>We developed the Progression and Transmission of HIV/AIDS model, a health state transition model that tracks index patients and their infected partners from HIV infection to death. We used program characteristics for each setting to compare the incremental cost per quality-adjusted life year gained from early versus late diagnosis and treatment. We ran the model for 10,000 index patients for each setting, examining alternative scenarios, excluding and including transmission to partners, and assuming HAART was initiated at a CD4 count of either 350 or 500 cells/µL. Screening in STD clinics and EDs was cost-effective compared with diagnosing inpatients, even when including only the benefits to the index patients. Screening patients in STD clinics, who have less-advanced disease, was cost-effective compared with ED screening when treatment with HAART was initiated at a CD4 count of 500 cells/µL. When the benefits of reduced transmission to partners from early diagnosis were included, screening in settings with less-advanced disease stages was cost-saving compared with screening later in the course of infection. The study was limited by a small number of observations on CD4 count at diagnosis and by including transmission only to first generation partners of the index patients.<h4>Conclusions</h4>HIV prevention efforts can be advanced by screening in settings where patients present with less-advanced stages of HIV infection and by initiating treatment with HAART earlier in the course of infection.
format	article
author	Vimalanand S Prabhu Paul G Farnham Angela B Hutchinson Sada Soorapanth James D Heffelfinger Matthew R Golden John T Brooks David Rimland Stephanie L Sansom
author_facet	Vimalanand S Prabhu Paul G Farnham Angela B Hutchinson Sada Soorapanth James D Heffelfinger Matthew R Golden John T Brooks David Rimland Stephanie L Sansom
author_sort	Vimalanand S Prabhu
title	Cost-effectiveness of HIV screening in STD clinics, emergency departments, and inpatient units: a model-based analysis.
title_short	Cost-effectiveness of HIV screening in STD clinics, emergency departments, and inpatient units: a model-based analysis.
title_full	Cost-effectiveness of HIV screening in STD clinics, emergency departments, and inpatient units: a model-based analysis.
title_fullStr	Cost-effectiveness of HIV screening in STD clinics, emergency departments, and inpatient units: a model-based analysis.
title_full_unstemmed	Cost-effectiveness of HIV screening in STD clinics, emergency departments, and inpatient units: a model-based analysis.
title_sort	cost-effectiveness of hiv screening in std clinics, emergency departments, and inpatient units: a model-based analysis.
publisher	Public Library of Science (PLoS)
publishDate	2011
url	https://doaj.org/article/f2d6c6b591f04e77a3ef368d16f9caf3
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Cost-effectiveness of HIV screening in STD clinics, emergency departments, and inpatient units: a model-based analysis.

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