COST-EFFECTIVENESS OF THE ‘ONE4ALL' HIV LINKAGE INTERVENTION IN GUANGXI PROVINCE, CHINA

Purpose: To determine the incremental cost-effectiveness of the One4all HIV testing intervention, a novel testing algorithm consisting of rapid point-of-care (POC) HIV screening and CD4 testing,with viral load testing in parallel, designed to enhance completeness of diagnostic assessment, delivered at county hospitals in Guangxi, China, compared to the current standard of care.

Method: We adapted and extended a previously validated deterministic transmission model to prospectively estimate the health benefits and costs for One4All implemented scenario and stand of care. The model partitioned Guangxi population aged 15-64 on the basis of risk behaviour, and further comparted them according to screening status, HIV infection, diagnosis status, ART receipt and CD4 cell counts. The transition between states was according to a series of differential equations and disease progression measured by CD4 cell counts was according to the transition matrix derived from Multi-state Markov Model. The study incoporated data from the One4All trial, Chinese Center for Disease Control and Prevention HIV registry and published reports. In addition to ascertain HIV incidence aand mortality, cost-effectiveness analysis was conducted to estimate the incremental cost-effectiveness ratio measured by dollar per quality-adjusted life-year saved at 1, 5 and 25 years time horizon from the perspective of health system.

Result: The cost of the One4All testing algorithm was higher than the standard of care (RMB 2,182 vs. RMB 846), but facilitated earlier ART access, resulting in delayed disease progression and mortality. Over a 25-year time horizon, we estimated that introducing One4All in Guangxi Province would result in decreases of 0.5% and 1.5% in HIV incidence and mortality respectively at an ICER of RMB 11,678 per QALY gained. The sensitivity analysis showed that one4All remained cost-effective at even minimal levels of effectiveness in HIV testing uptake. Results were robust to changes to a range of parameters characterizing the HIV epidemic over time.

Conclusion: The One4All HIV testing strategy was highly cost-effective by WHO standards, and should be prioritized for widespread implementation in Guangxi province, China.  Integrating the intervention within a broader combination prevention strategy would serve to optimize the public health response to HIV/AIDS in Guangxi.