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Sunday, 23 October 2005 - 8:30 AM

THE COST-EFFECTIVENESS OF HIV SCREENING IN A RESOURCE-LIMITED COUNTRY: A MODEL OF SCREENING IN RUSSIA

Swati P. Tole, MD1, Gillian D. Sanders, PhD2, Ahmed M. Bayoumi, MD, MSc3, Cristina M. Galvin, MA, MSc1, Tatyana N. Vinichenko, MD1, Elisa F. Long, MS1, Margaret L. Brandeau, PhD1, and Douglas K. Owens, MD, MS4. (1) Stanford University, Stanford, CA, (2) Duke University, Durham, NC, (3) St. Michael's Hospital, University of Toronto, Toronto, ON, Canada, (4) VA Palo Alto Health Care System, Stanford, CA

Currently, the Russian Federation performs annual HIV testing of approximately 15% of its residents, many of whom do not belong to high-risk groups. Despite these substantial screening efforts, only 1-5% of those in need of highly active antiretroviral therapy (HAART) receive it. Our study evaluates the cost-effectiveness of HIV screening in Russia.

We used a Markov model to estimate costs, quality of life, and survival associated with a voluntary HIV screening program compared to no screening in Russia. We modeled a cohort of 15-49 year olds demographically similar to Russia's population, with an average age of 32.5. HIV prevalence in the base case was 1.1%, with two thirds of HIV cases undiagnosed. Our base case assumed 70% of those with a positive HIV test would enter care and receive appropriate treatment, as a best case scenario. We included costs of testing, counseling, follow up, and treatment. The annual cost of HAART was estimated to be $1700 for medications plus $600 for social support services. We measured lifetime health care costs and quality-adjusted life years (QALYs) gained, discounted by 3% annually.

Once per lifetime HIV screening increased life expectancy by 1.80 QALYs for infected individuals. For the entire screened population, life expectancy increased by 3.2 quality-adjusted days at an estimated incremental cost of $68, yielding a cost-effectiveness ratio of $7660/QALY gained. When the annual cost of HAART was decreased to $1200, the cost-effectiveness ratio was $5040/QALY gained. In a more realistic scenario in which only 10% of infected individuals were treated, the cost-effectiveness ratio of screening increased to $8070/QALY gained. When prevalence of the screened population was lowered to 0.1%, the cost-effectiveness ratio worsened to $9320/QALY gained; in a higher prevalence scenario of 30%, the ratio decreased modestly to $7400/QALY gained. These analyses do not include the potential public health benefits of reduced transmission due to behavior change and treatment; incorporation of these benefits would yield more favorable cost-effectiveness ratios.

Our findings suggest that once per lifetime HIV screening in Russia is cost-effective by the World Health Organization's cost-effectiveness guidelines. To improve the cost-effectiveness of screening, efforts should focus on reducing costs of HAART, ensuring that HIV-infected individuals receive treatment, and preferential screening of high-risk groups.


See more of Oral Concurrent Session C - Public Health
See more of The 27th Annual Meeting of the Society for Medical Decision Making (October 21-24, 2005)