Cost-effectiveness of adoption strategies for point of care HIV viral load monitoring in South Africa
© 2020 The Author(s)..
BACKGROUND: Viral load (VL) testing is recommended for monitoring people on ART. The National Health Laboratory Service (NHLS) in South Africa conducts >5million laboratory-based VL tests but faces challenges with specimen integrity and results delivery. Point-of-care (POC) VL monitoring may improve VL suppression (VLS). We assessed the cost-effectiveness of different strategies for POC testing in South Africa.
METHODS: We developed a cost-outcome model utilizing NHLS data, including facility-level annual VL volumes, proportion with VLS, specimen rejection rates, turn-around-time, and the cost/test. We assessed the impact of adopting POC VL technology under 4 strategies: (1) status-quo; (2) targeted POC testing at facilities with high levels of viral failure; (3) targeted POC testing at low-performing facilities; (4) complete POC adoption. For each strategy, we determined the total cost, effectiveness (expected number of virally suppressed people) and incremental cost-effectiveness ratio (ICER) based on expected (>10%) VLS improvement.
FINDINGS: Existing laboratory-based VL testing costs $126 m annually and achieves 85.2% VLS. Strategy 2 was the most cost-effective approach, with 88.5% VLS and $40/additional person suppressed, compared to the status-quo. Should resources allow, complete POC adoption may be cost-effective (ICER: $136/additional person suppressed), requiring an additional $49 m annually and achieving 94.5% VLS. All other strategies were dominated in the incremental analysis.
INTERPRETATION: Assuming POC VL monitoring confers clinical benefits, the most cost-effective strategy for POC adoption in South Africa is a targeted approach with POC VL technologies placed at facilities with high level of viral failure.
FUNDING: Funding support from the Bill & Melinda Gates Foundation.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:28 |
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| Enthalten in: |
EClinicalMedicine - 28(2020) vom: 18. Nov., Seite 100607 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Girdwood, Sarah J [VerfasserIn] |
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| Links: |
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| Themen: |
Cost-effectiveness |
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| Anmerkungen: |
Date Revised 18.04.2022 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1016/j.eclinm.2020.100607 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 520 | |a © 2020 The Author(s). | ||
| 520 | |a BACKGROUND: Viral load (VL) testing is recommended for monitoring people on ART. The National Health Laboratory Service (NHLS) in South Africa conducts >5million laboratory-based VL tests but faces challenges with specimen integrity and results delivery. Point-of-care (POC) VL monitoring may improve VL suppression (VLS). We assessed the cost-effectiveness of different strategies for POC testing in South Africa | ||
| 520 | |a METHODS: We developed a cost-outcome model utilizing NHLS data, including facility-level annual VL volumes, proportion with VLS, specimen rejection rates, turn-around-time, and the cost/test. We assessed the impact of adopting POC VL technology under 4 strategies: (1) status-quo; (2) targeted POC testing at facilities with high levels of viral failure; (3) targeted POC testing at low-performing facilities; (4) complete POC adoption. For each strategy, we determined the total cost, effectiveness (expected number of virally suppressed people) and incremental cost-effectiveness ratio (ICER) based on expected (>10%) VLS improvement | ||
| 520 | |a FINDINGS: Existing laboratory-based VL testing costs $126 m annually and achieves 85.2% VLS. Strategy 2 was the most cost-effective approach, with 88.5% VLS and $40/additional person suppressed, compared to the status-quo. Should resources allow, complete POC adoption may be cost-effective (ICER: $136/additional person suppressed), requiring an additional $49 m annually and achieving 94.5% VLS. All other strategies were dominated in the incremental analysis | ||
| 520 | |a INTERPRETATION: Assuming POC VL monitoring confers clinical benefits, the most cost-effective strategy for POC adoption in South Africa is a targeted approach with POC VL technologies placed at facilities with high level of viral failure | ||
| 520 | |a FUNDING: Funding support from the Bill & Melinda Gates Foundation | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Cost-effectiveness | |
| 650 | 4 | |a Point of care | |
| 650 | 4 | |a South Africa | |
| 650 | 4 | |a Viral load scale-up | |
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| 700 | 1 | |a Sharma, Monisha |e verfasserin |4 aut | |
| 700 | 1 | |a Dorward, Jienchi |e verfasserin |4 aut | |
| 700 | 1 | |a Garrett, Nigel |e verfasserin |4 aut | |
| 700 | 1 | |a Drain, Paul K |e verfasserin |4 aut | |
| 700 | 1 | |a Stevens, Wendy |e verfasserin |4 aut | |
| 700 | 1 | |a Nichols, Brooke E |e verfasserin |4 aut | |
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