Modeling the cost–effectiveness of health programs: HIV testing and early treatment in the USA

2011 ◽  
Vol 6 (7) ◽  
pp. 725-729 ◽  
Author(s):  
Eduard J Beck
Keyword(s):  
Cost Effectiveness ◽  
Hiv Testing ◽  
Early Treatment ◽  
Health Programs ◽  
The Usa ◽  
The Cost

scholarly journals Cost-Effectiveness of Peer-Delivered HIV Self-Tests for MSM in Uganda

2021 ◽  
Vol 9 ◽  
Author(s):  
Stephen Okoboi ◽  
Barbara Castelnuovo ◽  
Jean-Pierre Van Geertruyden ◽  
Oucul Lazarus ◽  
Lung Vu ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Hiv Testing ◽  
Cost Effective ◽  
Hiv Infections ◽  
Standard Of Care ◽  
Sub Saharan Africa ◽  
High Risk Population ◽  
Self Testing ◽  
The Cost

Introduction: Distribution of HIV self-testing (HIVST) kits through MSM peer networks is a novel and effective strategy to increase HIV testing coverage in this high-risk population. No study has evaluated the cost or cost effectiveness of peer distribution of HIVST strategies among MSM in sub-Saharan Africa.Methods: From June to August 2018, we conducted a pilot study of secondary MSM peer HIVST kit distribution at The AIDS Support Organization at Entebbe and Masaka. We used an ingredients approach to estimate the cost of MSM peer HIVST kit distribution relative to standard-of-care (SOC) hotspot testing using programme expenditure data reported in US dollars. The provider perspective was used to estimate incremental cost-effective ratios per HIV infection averted using the difference in HIV annual transmission rates between MSM with HIV who knew their status and were not virologically suppressed and MSM with HIV who did not know their status.Results: We enrolled 297 participants of whom 150 received MSM peer HIVST kit distribution (intervention group) and 147 received TASO standard of care HIV testing (control group). Provider cost for the intervention was $2,276 compared with $1,827 for SOC during the 3-month study period. Overall, the intervention resulted in higher HIV positivity yield (4.9 vs. 1.4%) and averted more HIV infections per quarter (0.364 vs. 0.104) compared with SOC. The cost per person tested was higher for the intervention compared to SOC ($15.90 vs. $12.40). Importantly, the cost per new HIV diagnosis ($325 vs. $914) and cost per transmission averted ($6,253 vs. $ 17,567) were lower for the intervention approach relative to SOC. The incremental cost per HIV transmission averted by the self-testing program was $1,727. The incremental cost to providers per additional HIV-positive person identified by the intervention was $147.30.Conclusion: The intervention strategy was cost-effective, and identified more undiagnosed HIV infections than SOC hotspot testing at a cost-effectiveness threshold of US $2,129. Secondary distribution of HIVST kits through peers should further be evaluated with longer duration aimed at diagnosing 95% of all persons with HIV by 2030; the first UNAIDS 95-95-95 target.

An Economic Evaluation of a Community-Based Organization Led HIV Self-Testing Program Among Men Who Have Sex With Men in China

2020 ◽  
Author(s):  
Shanzi Huang ◽  
Jason Ong ◽  
Wencan Dai ◽  
Xi He ◽  
Yi Zhou ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hiv Testing ◽  
Variable Cost ◽  
Community Based ◽  
Self Testing ◽  
Hiv Test ◽  
Community Based Organization ◽  
The Mean ◽  
The Cost ◽  
Mean Cost

Abstract Introduction: HIV self-testing (HIVST) is effective in improving the uptake of HIV testing among key populations. Complementary data on the cost-effectiveness of HIVST is critical for planning and scaling up HIVST. This study aimed to evaluate the cost-effectiveness of a community-based organization (CBO)-led HIVST model implemented in China. Method: A cost-effectiveness analysis (CEA) was conducted by comparing a CBO-led HIVST model with a CBO-led facility-based HIV rapid diagnostics testing (HIV-RDT) model. The full economic cost, including fixed and variable cost, from a health provider perspective using a micro costing approach was estimated. We determined the cost-effectiveness of these two HIV testing models over a two year time horizon (i.e. duration of the programs), and reported costs using US dollars (2020). Results: From January 2017 to December 2018, a total of 4,633 men tested in the HIVST model, and 1,780 men tested in the HIV-RDT model. The total number of new diagnosis was 155 for HIVST and 126 for the HIV-RDT model; the HIV test positivity was 3.3% (95% confidence interval (CI): 2.8-3.9) for the HIVST model and 7.1% (95% CI: 5.9-8.4) for the HIV-RDT model. The mean cost per person tested was $14.57 for HIVST and $24.74 for HIV-RDT. However, the mean cost per diagnosed was higher for HIVST ($435.52) compared with $349.44 for HIV-RDT.Conclusion: Our study confirms that compared to facility-based HIV-RDT, a community-based organization led HIVST program could have a cheaper mean cost per MSM tested for HIV in China. Better targeting of high-risk individuals would further improve the cost-effectiveness of HIVST.

scholarly journals The Cost-effectiveness of Human Immunodeficiency Virus (HIV) Preexposure Prophylaxis and HIV Testing Strategies in High-risk Groups in India

2019 ◽  
Vol 70 (4) ◽  
pp. 633-642 ◽  
Author(s):  
Pooyan Kazemian ◽  
Sydney Costantini ◽  
Nagalingeswaran Kumarasamy ◽  
A David Paltiel ◽  
Kenneth H Mayer ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hiv Testing ◽  
Scale Up ◽  
Cost Effective ◽  
Status Quo ◽  
Hiv Incidence ◽  
Testing Strategies ◽  
Preexposure Prophylaxis ◽  
Immunodeficiency Virus ◽  
The Cost

Abstract Background The human immunodeficiency virus (HIV) epidemic in India is concentrated among 3.1 million men who have sex with men (MSM) and 1.1 million people who inject drugs (PWID), with a mean incidence of 0.9–1.4 per 100 person-years. We examined the cost-effectiveness of both preexposure prophylaxis (PrEP) and HIV testing strategies for MSM and PWID in India. Methods We populated an HIV microsimulation model with India-specific data and projected clinical and economic outcomes of 7 strategies for MSM/PWID, including status quo; a 1-time HIV test; routine HIV testing every 3, 6, or 12 months; and PrEP with HIV testing every 3 or 6 months. We used a willingness-to-pay threshold of US$1950, the 2017 Indian per capita gross domestic product, to define cost-effectiveness. Results HIV testing alone increased life expectancy by 0.07–0.30 years in MSM; PrEP added approximately 0.90 life-years to status quo. Results were similar in PWID. PrEP with 6-month testing was cost-effective for both MSM (incremental cost-effectiveness ratio [ICER], $1000/year of life saved [YLS]) and PWID (ICER, $500/YLS). Results were most sensitive to HIV incidence. PrEP with 6-month testing would increase HIV-related expenditures by US$708 million (MSM) and US$218 million (PWID) over 5 years compared to status quo. Conclusions While the World Health Organization recommends PrEP with quarterly HIV testing, our analysis identifies PrEP with semiannual testing as the cost-effective HIV prevention strategy for Indian MSM and PWID. Since nationwide scale-up would require a substantial fiscal investment, areas of highest HIV incidence may be the appropriate initial targets for PrEP scale-up.

scholarly journals The Cost Effectiveness of Lisdexamfetamine Dimesylate for the Treatment of Binge Eating Disorder in the USA

2016 ◽  
Vol 36 (4) ◽  
pp. 305-312 ◽  
Author(s):  
Tamás Ágh ◽  
Manjiri Pawaskar ◽  
Balázs Nagy ◽  
Jean Lachaine ◽  
Zoltán Vokó
Keyword(s):  
Eating Disorder ◽  
Cost Effectiveness ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Lisdexamfetamine Dimesylate ◽  
The Usa ◽  
The Cost

scholarly journals Cost-effectiveness of single-dose zoledronic acid for nursing home residents with osteoporosis in the USA

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e022585 ◽  
Author(s):  
Kouta Ito
Keyword(s):  
Nursing Home ◽  
Single Dose ◽  
Cost Effectiveness ◽  
Zoledronic Acid ◽  
Usual Care ◽  
Nursing Home Residents ◽  
Cost Effective ◽  
Routine Administration ◽  
The Usa ◽  
The Cost

ObjectiveTo evaluate the cost-effectiveness of routine administration of single-dose zoledronic acid for nursing home residents with osteoporosis in the USA.DesignMarkov cohort simulation model based on published literature from a healthcare sector perspective over a lifetime horizon.SettingNursing homes.ParticipantsA hypothetical cohort of nursing home residents aged 85 years with osteoporosis.InterventionsTwo strategies were compared: (1) a single intravenous dose of zoledronic acid 5 mg and (2) usual care (supplementation of calcium and vitamin D only).Primary and secondary outcome measuresIncremental cost-effectiveness ratio (ICER), as measured by cost per quality-adjusted life year (QALY) gained.ResultsCompared with usual care, zoledronic acid had an ICER of $207 400 per QALY gained and was not cost-effective at a conventional willingness-to-pay threshold of $100 000 per QALY gained. The results were robust to a reasonable range of assumptions about incidence, mortality, quality-of-life effects and the cost of hip fracture and the cost of zoledronic acid. Zoledronic acid had a potential to become cost-effective if a fracture risk reduction with zoledronic acid was higher than 23% or if 6-month mortality in nursing home residents was lower than 16%. Probabilistic sensitivity analysis showed that the zoledronic acid would be cost-effective in 14%, 27% and 44% of simulations at willingness-to-pay thresholds of $50 000, $100 000 or $200 000 per QALY gained, respectively.ConclusionsRoutine administration of single-dose zoledronic acid in nursing home residents with osteoporosis is not a cost-effective use of resources in the USA but could be justifiable in those with a favourable life expectancy.

Cost-effectiveness of clozapine

1997 ◽  
Vol 171 (2) ◽  
pp. 125-130 ◽  
Author(s):  
Katherine J. Aitchison ◽  
Robert W Kerwin
Keyword(s):  
Cost Effectiveness ◽  
Community Setting ◽  
Chronic Schizophrenia ◽  
Naturalistic Study ◽  
Clozapine Treatment ◽  
Effectiveness Analysis ◽  
The Usa ◽  
Prescription Costs ◽  
The Uk ◽  
The Cost

BackgroundSchizophrenia is highly expensive in calculable and incalculable costs. Measures which impact the cost in the most severely affected are likely to produce the greatest cost reductions. Studies regarding clozapine in the USA have demonstrated clear cost-effectiveness, despite the high prescription costs. There are no prior UK studies.MethodWe performed a cost-effectiveness analysis comparing the three years prior to commencing clozapine to the period following establishment of clozapine treatment (mean 36.4 months) for 26 patients with chronic schizophrenia or schizoaffective disorder.ResultsThere was a significant improvement in all clinical ratings applied (and a mean net saving of £3768 per annum). The cost-effectiveness of clozapine was double that of conventional neuroleptics (15.2 pre-, 33.0 post-clozapine, P < 0.005).ConclusionsAs a naturalistic study our data provide valuable information on the cost-effectiveness of clozapine in the UK. Our methodology could be applied in a community setting or in the study of another atypical neuroleptic.

scholarly journals The Potential Epidemiological Impact of Coronavirus Disease 2019 (COVID-19) on the Human Immunodeficiency Virus (HIV) Epidemic and the Cost-effectiveness of Linked, Opt-out HIV Testing: A Modeling Study in 6 US Cities

2020 ◽  
Author(s):  
Xiao Zang ◽  
Emanuel Krebs ◽  
Siyuan Chen ◽  
Micah Piske ◽  
Wendy S Armstrong ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hiv Testing ◽  
Risk Behaviors ◽  
Hiv Infections ◽  
Case Scenario ◽  
Opt Out ◽  
Immunodeficiency Virus ◽  
The Cost ◽  
Us Cities ◽  
Care Costs

Abstract Background Widespread viral and serological testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may present a unique opportunity to also test for human immunodeficiency virus (HIV) infection. We estimated the potential impact of adding linked, opt-out HIV testing alongside SARS-CoV-2 testing on the HIV incidence and the cost-effectiveness of this strategy in 6 US cities. Methods Using a previously calibrated dynamic HIV transmission model, we constructed 3 sets of scenarios for each city: (1) sustained current levels of HIV-related treatment and prevention services (status quo); (2) temporary disruptions in health services and changes in sexual and injection risk behaviors at discrete levels between 0%–50%; and (3) linked HIV and SARS-CoV-2 testing offered to 10%–90% of the adult population in addition to Scenario 2. We estimated the cumulative number of HIV infections between 2020–2025 and the incremental cost-effectiveness ratios of linked HIV testing over 20 years. Results In the absence of linked, opt-out HIV testing, we estimated a total of a 16.5% decrease in HIV infections between 2020–2025 in the best-case scenario (50% reduction in risk behaviors and no service disruptions), and a 9.0% increase in the worst-case scenario (no behavioral change and 50% reduction in service access). We estimated that HIV testing (offered at 10%–90% levels) could avert a total of 576–7225 (1.6%–17.2%) new infections. The intervention would require an initial investment of $20.6M–$220.7M across cities; however, the intervention would ultimately result in savings in health-care costs in each city. Conclusions A campaign in which HIV testing is linked with SARS-CoV-2 testing could substantially reduce the HIV incidence and reduce direct and indirect health care costs attributable to HIV.

scholarly journals The cost-effectiveness analysis of drug therapy versus surgery for symptomatic adenoid hypertrophy by a Markov model

2019 ◽  
Vol 29 (3) ◽  
pp. 629-638 ◽  
Author(s):  
Han Xiao ◽  
Jinqiang Huang ◽  
Weifeng Liu ◽  
Zihao Dai ◽  
Sui Peng ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Drug Therapy ◽  
Drug Group ◽  
Sensitivity Analyses ◽  
Model Parameters ◽  
Adenoid Hypertrophy ◽  
Surgery Group ◽  
Life Years ◽  
The Usa ◽  
The Cost

Abstract Purpose Adenoid hypertrophy (AH) is common among young children. Adenoid-based surgery and drug therapy could be applied for symptomatic AH patients, yet the treatment decision is difficult to make due to the diverse cost and efficacy between these two treatments. Methods A Markov simulation model was designed to estimate the cost-effectiveness (CE) of the adenoid-based surgery and the drug therapy for symptomatic AH patients. Transition probabilities, costs and utilities were extracted from early researches and expert opinions. Simulations using two set of parameter inputs for China and the USA were performed. Primary outcome was cost per QALY gained over a 6-year period. Deterministic and probabilistic sensitivity analyses were also conducted. Results The utility for the surgery group and the drug group were 4.10 quality-adjusted life years (QALYs) and 3.58 QALYs, respectively. The cost of the surgery group was more than that of the drug group using model parameters specific to China ($1069.0 vs. $753.7) but was less for the USA ($1994.4 vs. $3977.7). Surgery was dominant over drug therapy when US specific parameters were used. Surgery group had an ICER of $604.0 per QALY when parameters specific to China was used. Conclusion Surgery is cost-effective in the simulations for both China and the USA at WTP thresholds of $9633.1 and $62,517.5, respectively.

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