Offering HIV testing to individuals at health checks once they register at a new GP surgery in high-prevalence areas is cost-efficient and will save lives, per a study involving over 86,000 folks from 40 GP surgeries, LED by Queen Mary University of London (QMUL) and also the London School of Hygiene & tropical medicine.
The researcher’s area unit calling on health care commissioners to invest urgently within the roll out of HIV screening to all 74 high HIV prevalence local authorities in a European country (those with more than two diagnosed HIV infections per one,000 adults).
People with HIV have a close to traditional anticipation if they are diagnosed early and have treatment, and people taking effective treatment are no longer infectious to others. but within the UK around 13,500 folks don’t understand that they have HIV, that means they miss out on treatment, stay infectious to others and become dearer to treat in the future.
HIV treatment is expensive and increased testing may doubtless additional increase costs. Health care planners want reliable estimates of the cost-effectiveness of screening but estimates are few and up to now, have not been supported sturdy knowledge from randomized controlled trials.
Dr. Werner Leber from QMUL said: “We’ve shown that HIV screening in UK primary care is cost effective and doubtless cost saving, which is contrary to widespread belief. this is often a very important finding given today’s self-discipline. monetary pressures, significantly among native authority’s public health budgets, mean that the costs of HIV testing area unit beneath intense scrutiny, and in some areas investment in testing has fallen.”
Dr. Clare Highton, town and Hackney Clinical commissioning cluster (CCG) said: “Public health, specialist, and CCG commissioners should observe of those vital results showing the worth for money of screening for HIV in primary care. This intervention implies that folks with HIV area unit ready to live longer and healthier lives and also the spread of infection to others are halted.”
The study, revealed within the Lancet HIV, examined data from an earlier research trial in Hackney – a socio-economically deprived inner London borough with an HIV prevalence rate of 8 per 1000 adults. The trial concerned 40 general practices, wherever they tested the impact of fast finger-prick HIV testing as a part of the quality medical checkup throughout registration and located it LED to a fourfold higher HIV diagnosis rate.
Using a mathematical model that features all the costs related to HIV testing and treatment, the team currently show that primary care HIV screening in high prevalence settings becomes cost-effective in 33 years (according to National Institute for Health and Care Excellence [NICE] criteria).
Factoring in the higher costs of look after folks whose HIV is diagnosed late, they were ready to predict that HIV screening may become cost-efficient so much previous this, and should even become cost-saving if the long Aid costs of late-diagnosed patients area unit abundant higher than those of patients diagnosed earlier, as has been ascertained in Canada.
Eleven authorities have HIV prevalence just like Hackney and 74 of 325 authorities in England area unit outlined by NICE as high prevalence and will benefit from screening. The calculable annual cost of rolling out the screening program to all or any 11 Hackney-level HIV prevalence authorities would be close to £600,000 (£4 million for roll-out to all or any 74 high prevalence authorities). This doesn’t embrace exaggerated health care costs ensuing from earlier HIV diagnosis and treatment which might represent alternative NHS budgets.
Dr Rebecca Baggaley, lead author of the study and Honorary Lecturer at the London School of Hygiene & tropical medicine, stated that: “Currently NICE uses a threshold of £20,000 to £30,000 per Quality Adjusted Life Year (QALY) gained to determine whether or not the health edges of an intervention supply value for money to the NHS and its patients. ‘QALY’ may be a wide used live of health that mixes length and quality of life. we have a tendency to found that over 40 years, primary care-based HIV screening in high prevalence areas would cost an estimated £26,626 per QALY gained and so warrants funding within the UK.”
The study has some limitations as some data, including the probability of viral transmission to partners and quality of life, are estimated supported international literature and should therefore not accurately mirror the Hackney scenario.
The study was funded by NHS town and Hackney and UK Department of Health and involved University school London, Homerton University Hospital NHS Foundation Trust, University of Warwick, and the University of British Columbia.
Article: Cost-effectiveness of screening for HIV in primary care: a health economics modelling analysis, Dr Rebecca F Baggaley et al., The Lancet HIV, doi: 10.1016/S2352-3018(17)30123-6, published 30 July 2017.