Cost-effectiveness of Frequent HIV Screening Among High-risk Young Men Who Have Sex With Men in the United States
© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissionsoup.com..
BACKGROUND: Of new HIV infections in the US, 20% occur among young men who have sex with men (YMSM, ages 13-24), but >50% of YMSM with HIV are unaware of their status. Using Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) data, we projected the clinical benefit and cost-effectiveness of frequent HIV screening among high-risk YMSM from age 15.
METHODS: Using a mathematical simulation, we examined 3 screening strategies: Yearly, 6-monthly, and 3-monthly, each in addition to the Status quo (SQ, 0.7-10.3% screened/year, stratified by age). We used published data (YMSM-specific when available) including: HIV incidences (0.91-6.41/100PY); screen acceptance (80%), linkage-to-care/antiretroviral therapy (ART) initiation (76%), HIV transmission (0.3-86.1/100PY, by HIV RNA), monthly ART costs ($2290-$3780), and HIV per-screen costs ($38). Projected outcomes included CD4 count at diagnosis, primary HIV transmissions from ages 15-30, quality-adjusted life expectancy, costs, and incremental cost-effectiveness ratios (ICERs, $/quality-adjusted life-year saved [QALY]; threshold ≤$100 000/QALY).
RESULTS: Compared to SQ, all strategies increased projected CD4 at diagnosis (296 to 477-515 cells/µL) and quality-adjusted life expectancy from age 15 (44.4 to 48.3-48.7 years) among YMSM acquiring HIV. Compared to SQ, all strategies increased discounted lifetime cost for the entire population ($170 800 to $178 100-$185 000/person). Screening 3-monthly was cost-effective (ICER: $4500/QALY) compared to SQ and reduced primary transmissions through age 30 by 40%. Results were most sensitive to transmission rates; excluding the impact of transmissions, screening Yearly was ≤$100 000/QALY (ICER: $70 900/QALY).
CONCLUSIONS: For high-risk YMSM in the US, HIV screening 3-monthly compared to less frequent screening will improve clinical outcomes and be cost-effective.
| Errataetall: |
CommentIn: Clin Infect Dis. 2021 Oct 5;73(7):e1936-e1937. - PMID 32730624 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:73 |
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| Enthalten in: |
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America - 73(2021), 7 vom: 05. Okt., Seite e1927-e1935 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Neilan, Anne M [VerfasserIn] |
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| Links: |
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| Themen: |
Adolescents and young adults |
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| Anmerkungen: |
Date Completed 20.10.2021 Date Revised 12.01.2022 published: Print CommentIn: Clin Infect Dis. 2021 Oct 5;73(7):e1936-e1937. - PMID 32730624 Citation Status MEDLINE |
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| doi: |
10.1093/cid/ciaa1061 |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Cost-effectiveness of Frequent HIV Screening Among High-risk Young Men Who Have Sex With Men in the United States |
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| 500 | |a Date Revised 12.01.2022 | ||
| 500 | |a published: Print | ||
| 500 | |a CommentIn: Clin Infect Dis. 2021 Oct 5;73(7):e1936-e1937. - PMID 32730624 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissionsoup.com. | ||
| 520 | |a BACKGROUND: Of new HIV infections in the US, 20% occur among young men who have sex with men (YMSM, ages 13-24), but >50% of YMSM with HIV are unaware of their status. Using Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) data, we projected the clinical benefit and cost-effectiveness of frequent HIV screening among high-risk YMSM from age 15 | ||
| 520 | |a METHODS: Using a mathematical simulation, we examined 3 screening strategies: Yearly, 6-monthly, and 3-monthly, each in addition to the Status quo (SQ, 0.7-10.3% screened/year, stratified by age). We used published data (YMSM-specific when available) including: HIV incidences (0.91-6.41/100PY); screen acceptance (80%), linkage-to-care/antiretroviral therapy (ART) initiation (76%), HIV transmission (0.3-86.1/100PY, by HIV RNA), monthly ART costs ($2290-$3780), and HIV per-screen costs ($38). Projected outcomes included CD4 count at diagnosis, primary HIV transmissions from ages 15-30, quality-adjusted life expectancy, costs, and incremental cost-effectiveness ratios (ICERs, $/quality-adjusted life-year saved [QALY]; threshold ≤$100 000/QALY) | ||
| 520 | |a RESULTS: Compared to SQ, all strategies increased projected CD4 at diagnosis (296 to 477-515 cells/µL) and quality-adjusted life expectancy from age 15 (44.4 to 48.3-48.7 years) among YMSM acquiring HIV. Compared to SQ, all strategies increased discounted lifetime cost for the entire population ($170 800 to $178 100-$185 000/person). Screening 3-monthly was cost-effective (ICER: $4500/QALY) compared to SQ and reduced primary transmissions through age 30 by 40%. Results were most sensitive to transmission rates; excluding the impact of transmissions, screening Yearly was ≤$100 000/QALY (ICER: $70 900/QALY) | ||
| 520 | |a CONCLUSIONS: For high-risk YMSM in the US, HIV screening 3-monthly compared to less frequent screening will improve clinical outcomes and be cost-effective | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a HIV | |
| 650 | 4 | |a Young men who have sex with men | |
| 650 | 4 | |a adolescents and young adults | |
| 650 | 4 | |a cost-effectiveness | |
| 650 | 4 | |a screening | |
| 700 | 1 | |a Bulteel, Alexander J B |e verfasserin |4 aut | |
| 700 | 1 | |a Hosek, Sybil G |e verfasserin |4 aut | |
| 700 | 1 | |a Foote, Julia H A |e verfasserin |4 aut | |
| 700 | 1 | |a Freedberg, Kenneth A |e verfasserin |4 aut | |
| 700 | 1 | |a Landovitz, Raphael J |e verfasserin |4 aut | |
| 700 | 1 | |a Walensky, Rochelle P |e verfasserin |4 aut | |
| 700 | 1 | |a Resch, Stephen C |e verfasserin |4 aut | |
| 700 | 1 | |a Kazemian, Pooyan |e verfasserin |4 aut | |
| 700 | 1 | |a Paltiel, A David |e verfasserin |4 aut | |
| 700 | 1 | |a Weinstein, Milton C |e verfasserin |4 aut | |
| 700 | 1 | |a Wilson, Craig M |e verfasserin |4 aut | |
| 700 | 1 | |a Ciaranello, Andrea L |e verfasserin |4 aut | |
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