title: The cost-effectiveness of symptom-based testing and routine screening for acute HIV infection in men who have sex with men in the USA.
abstract: OBJECTIVE
  Acute HIV infection often causes influenza-like illness (ILI) and is associated with high infectivity. We estimated the effectiveness and cost-effectiveness of strategies to identify and treat acute HIV infection in men who have sex with men (MSM) in the USA.
  
  
  METHODS
  Dynamic model of HIV transmission and progression.
  
  
  METHODS
  We evaluated three testing approaches: viral load testing for individuals with ILI, expanded screening with antibody testing, and expanded screening with antibody and viral load testing. We included treatment with antiretroviral therapy for individuals identified as acutely infected.
  
  
  METHODS
  New HIV infections, discounted quality-adjusted life years (QALYs) and costs, and incremental cost-effectiveness ratios.
  
  
  RESULTS
  At the present rate of HIV-antibody testing, we estimated that 538,000 new infections will occur among MSM over the next 20 years. Expanding antibody screening coverage to 90% of MSM annually reduces new infections by 2.8% and costs US$ 12,582 per QALY gained. Symptom-based viral load testing with ILI is more expensive than expanded antibody screening, but is more effective and costs US$ 22,786 per QALY gained. Combining expanded antibody screening with symptom-based viral load testing prevents twice as many infections compared to expanded antibody screening alone, and costs US$ 29,923 per QALY gained. Adding viral load testing to all annual HIV tests costs more than US$ 100,000 per QALY gained.
  
  
  CONCLUSIONS
  Use of HIV viral load testing in MSM with ILI prevents more infections than does expanded annual antibody screening alone and is inexpensive relative to other screening interventions. Clinicians should consider symptom-based viral load testing in MSM, in addition to encouraging annual antibody screening.
authors.affiliation: Department of Management Science and Engineering, Stanford University, California, USA. jjuusola@stanford.edu
authors.forename: Jessie L
authors.initials: JL
authors.lastname: Juusola
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Brandeau
authors.forename: Elisa F
authors.initials: EF
authors.lastname: Long
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Owens
authors.forename: Eran
authors.initials: E
authors.lastname: Bendavid
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D015483:HIV Antibodies / Q000097:blood*; D015658:HIV Infections / Q000175:diagnosis* / Q000191:economics* / Q000453:epidemiology / Q000276:immunology; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D019562:Viral Load / Q000191:economics*; D055815:Young Adult
chemical_list: D015483:HIV Antibodies