The Cost and Cost-Effectiveness of Alternative Strategies to Expand Treatment to HIV-Positive South Africans: Scale Economies and Outreach Costs

2015 ◽  
Author(s):  
Gesine Meyer-Rath ◽  
Mead Over ◽  
Daniel J Klein ◽  
Anna Bershteyn
Keyword(s):  
Cost Effectiveness ◽  
Scale Economies ◽  
Hiv Positive ◽  
Alternative Strategies ◽  
South Africans ◽  
The Cost

scholarly journals Cost-effectiveness of facility-based, stand-alone and mobile-based voluntary counseling and testing for HIV in Addis Ababa, Ethiopia

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Amanuel Yigezu ◽  
Senait Alemayehu ◽  
Shallo Daba Hamusse ◽  
Getachew Teshome Ergeta ◽  
Damen Hailemariam ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Addis Ababa ◽  
Unit Cost ◽  
Hiv Positive ◽  
Testing Methods ◽  
Voluntary Counseling ◽  
Voluntary Counseling And Testing ◽  
Counseling And Testing ◽  
The Cost ◽  
Hiv Seropositive

Abstract Background Globally, there is a consensus to end the HIV/AIDS epidemic by 2030, and one of the strategies to achieve this target is that 90% of people living with HIV should know their HIV status. Even if there is strong evidence of clients’ preference for testing in the community, HIV voluntary counseling and testing (VCT) continue to be undertaken predominantly in health facilities. Hence, empirical cost-effectiveness evidence about different HIV counseling and testing models is essential to inform whether such community-based testing are justifiable compared with additional resources required. Therefore, the purpose of this study was to compare the cost-effectiveness of facility-based, stand-alone and mobile-based HIV voluntary counseling and testing methods in Addis Ababa, Ethiopia. Methods Annual economic costs of counseling and testing methods were collected from the providers’ perspective from July 2016 to June 2017. Ingredients based bottom-up costing approach was applied. The effectiveness of the interventions was measured in terms of the number of HIV seropositive clients identified. Decision tree modeling was built using TreeAge Pro 2018 software, and one-way and probabilistic sensitivity analyses were conducted by varying HIV positivity rate, costs, and probabilities. Results The cost of test per client for facility-based, stand-alone and mobile-based VCT was $5.06, $6.55 and $3.35, respectively. The unit costs of test per HIV seropositive client for the corresponding models were $158.82, $150.97 and $135.82, respectively. Of the three models, stand-alone-based VCT was extendedly dominated. Mobile-based VCT costs, an additional cost of USD 239 for every HIV positive client identified when compared to facility-based VCT. Conclusion Using a mobile-based VCT approach costs less than both the facility-based and stand-alone approaches, in terms of both unit cost per tested individual and unit cost per HIV seropositive cases identified. The stand-alone VCT approach was not cost-effective compared to facility-based and mobile-based VCT. The incremental cost-effectiveness ratio for mobile-based VCT compared with facility-based VCT was USD 239 per HIV positive case.

Maternal tetanus immunization in Aceh Province, Sumatra: The cost-effectiveness of alternative strategies

1991 ◽  
Vol 33 (2) ◽  
pp. 185-192 ◽  
Author(s):  
Peter Berman ◽  
John Quinley ◽  
Burhannuddin Yusuf ◽  
Syaifuddin Anwar ◽  
Udin Mustaini ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Alternative Strategies ◽  
Aceh Province ◽  
Tetanus Immunization ◽  
The Cost

Alternative strategies to evaluate the cost-effectiveness of peritoneal dialysis and hemodialysis

2007 ◽  
Vol 39 (1) ◽  
pp. 289-298 ◽  
Author(s):  
Tapani Salonen ◽  
Tuomo Reina ◽  
Heikki Oksa ◽  
Pekka Rissanen ◽  
Amos Pasternack
Keyword(s):  
Peritoneal Dialysis ◽  
Cost Effectiveness ◽  
Alternative Strategies ◽  
The Cost

scholarly journals Management of End Stage Renal Disease in Persons Living with HIV: A Cost-Effectiveness Analysis

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S436-S436
Author(s):  
Winston B Joe ◽  
Ellen F Eaton
Keyword(s):  
Cost Effectiveness ◽  
Acute Rejection ◽  
Cost Effective ◽  
Small Sample ◽  
Sensitivity Analyses ◽  
Hiv Positive ◽  
Persons Living With Hiv ◽  
The Cost ◽  
Living With Hiv ◽  
Rejection Rates

Abstract Background HIV+ kidney transplant (KT) for persons living with HIV (PLWH) is both safe and effective, with comparable patient and graft survival rates relative to HIV- KT. The objective of this study was to evaluate the cost-effectiveness of HIV+ KT relative to HIV- KT and dialysis. Methods A decision-tree framework was used to assess the cost-effectiveness of the above treatment options for PLWH. Clinical outcomes at 3 years for KT and effectiveness data (expressed in QALYs) were abstracted from previous publications, when available. Costs were assigned from a payer’s perspective using the US Renal Data System and published literature (expressed in 2014 USD). This analysis assumed a three-year time horizon. Sensitivity analyses were explored to understand how changes in 1) acute KT rejection and 2) KT failure impact cost effectiveness. Limitations include small sample size and short follow up time in referenced studies and a lack of health utility data in HIV positive persons with renal failure. We used TreeAge Software (Williamstown, MA). Results HIV+ KT was most cost effective ($299,904/QALY) while both HIV- KT ($329,676) and dialysis ($444,645) were dominated, meaning more costly and less effective. Results were sensitive to the higher KT failure (26% vs. 16%) and acute rejection (39% vs. 17%) observed with HIV- KT relative to HIV+ KT. In sensitivity analysis, as HIV+ KT rejection rates approach 20%, HIV- KT becomes a cost-effective option. As HIV+ KT failure rates approach 26%, HIV- KT becomes cost effective. Conclusion Despite its limitations, this analysis demonstrates that HIV+ kidney transplantation is a cost-effective alternative for PLWH under certain conditions. As KT outcomes, like graft failure and acute rejection rates, continue to improve, it is likely that both HIV positive and negative KT will be cost-effective alternatives to dialysis. Disclosures All authors: No reported disclosures.

scholarly journals Evaluating the cost-effectiveness of TB diagnostic strategies in HIV-positive patients in Lusaka, Zambia

2012 ◽  
Vol 16 ◽  
pp. e286 ◽  
Author(s):  
L. Mishra ◽  
G. Henostroza ◽  
J. Harris ◽  
M. Siyambango ◽  
A. Krunner ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hiv Positive ◽  
Diagnostic Strategies ◽  
The Cost

PREVENTION COULD BE LESS COST-EFFECTIVE THAN CURE: THE CASE OF HEPATITIS C SCREENING POLICIES IN FRANCE

2003 ◽  
Vol 19 (4) ◽  
pp. 632-645 ◽  
Author(s):  
Sandrine Loubière ◽  
Michel Rotily ◽  
Jean-Paul Moatti
Keyword(s):  
Cost Effectiveness ◽  
Hepatitis C ◽  
General Population ◽  
Intravenous Drug User ◽  
Cost Effective ◽  
Screening Strategy ◽  
Additional Cost ◽  
Alternative Strategies ◽  
Hcv Screening ◽  
The Cost

Objectives: To access the cost-effectiveness of French recommendations for hepatitis C virus (HCV) screening and the extent to which earlier identification of carriers may or not improve the cost-effectiveness of therapeutic strategies.Methods: Cost-effectiveness analysis were performed using decision-tree analysis and a Markov model. Four alternative strategies were compared: no screening and no treatment; initiation of HCV treatment after the diagnosis of cirrhosis; and two alternative strategies refer to the current French policies of HCV testing, i.e., two enzyme immunoblot assay (EIA) tests in series, or a polymerase chain reaction (PCR) analysis after the first positive EIA test. Costs were computed from the viewpoint of the health care system. The analysis has been applied to populations particularly at risk of infection, as well as the general population.Results: The “wait and treat cirrhosis” strategy was more cost-effective in the general population and in transfusion recipients. The incremental cost-effectiveness ratio of this strategy compared with baseline strategy was 3,476 of euros and €15,300 in respective cohorts. Considering the HCV screening strategy, the additional cost would be of €4,933 and €240,250 per additional year of life saved, respectively. In the intravenous drug user (IDU) population, the “two EIA” screening strategy was the more cost-effective alternative, with an additional cost of €3,825 per additional year of life saved.Conclusions: HCV screening would be discarded for transfusion recipients but should be encouraged for IDUs and also for the general population, in which the additional cost of screening is an order of magnitude more acceptable.

scholarly journals Costs and Cost-Effectiveness of HIV Counselling and Testing Modalities in Southern Mozambique

2020 ◽  
Author(s):  
Jun Hao Choo ◽  
Elisa Lopez-Varela ◽  
Laura Fuente-Soro ◽  
Orvalho Augusto ◽  
Charfudin Sacoor ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Linkage To Care ◽  
Limited Resource ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Hiv Positive ◽  
Base Case ◽  
Positive Individual ◽  
Hiv Counselling And Testing ◽  
The Cost

Abstract Objective: Despite the high HIV associated burden, Mozambique lacks data on HIV counselling and testing (HCT) costs. To help guide national HIV/AIDS programs, we estimated the cost per test for voluntary counselling and testing (VCT) from the patient’s perspective and the costs per person tested and per HIV-positive individual linked to care to the healthcare provider for VCT, provider-initiated counselling and testing (PICT) and home-based testing (HBT). We also assessed the cost-effectiveness of these strategies for linking patients to care.Methods: Data from a cohort study conducted in the Manhiça District were used to derive costs and linkage-to-care outcomes of the three HCT strategies. A decision tree was used to model HCT costs according to the likelihood of HCT linking individuals to care and to obtain the incremental cost-effectiveness ratios (ICERs) of PICT and HBT with VCT as the comparator. Sensitivity analyses were performed to assess robustness of base-case findings. Findings: Average and median VCT costs to the patient per individual tested were US$1.34 and US$1.08, respectively. Costs per individual tested were greatest for HBT (US$11.07), followed by VCT (US$7.79), and PICT (US$7.14). The costs per HIV-positive individual linked to care followed a similar trend. PICT was not cost-effective in comparison with VCT at a willingness-to-accept threshold of US$4.53, but only marginally given a corresponding base-case ICER of US$4.15, while HBT was dominated, with higher costs and lower impact than VCT. Base-case results for the comparison between PICT and VCT presented great uncertainty, whereas findings for HBT were robust.Conclusion: PICT and VCT are likely equally cost-effective in Manhiça. We recommend that VCT be offered as the predominant HCT strategy in Mozambique, but expansion of PICT could be considered in limited-resource areas. HBT without facilitated linkage or reduced costs is unlikely to be cost-effective.

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