Expanded HIV testing in low-prevalence, high-income countries: a cost-effectiveness analysis for the United Kingdom.
OBJECTIVE
In many high-income countries with low HIV prevalence, significant numbers of persons living with HIV (PLHIV) remain undiagnosed. Identification of PLHIV via HIV testing offers timely access to lifesaving antiretroviral therapy (ART) and decreases HIV transmission. We estimated the effectiveness and cost-effectiveness of HIV testing in the United Kingdom (UK), where 25% of PLHIV are estimated to be undiagnosed.


METHODS
We developed a dynamic compartmental model to analyze strategies to expand HIV testing and treatment in the UK, with particular focus on men who have sex with men (MSM), people who inject drugs (PWID), and individuals from HIV-endemic countries.


METHODS
We estimated HIV prevalence, incidence, quality-adjusted life years (QALYs), and health care costs over 10 years, and cost-effectiveness.


RESULTS
Annual HIV testing of all adults could avert 5% of new infections, even with no behavior change following HIV diagnosis because of earlier ART initiation, or up to 18% if risky behavior is halved. This strategy costs £67,000-£106,000/QALY gained. Providing annual testing only to MSM, PWID, and people from HIV-endemic countries, and one-time testing for all other adults, prevents 4-15% of infections, requires one-fourth as many tests to diagnose each PLHIV, and costs £17,500/QALY gained. Augmenting this program with increased ART access could add 145,000 QALYs to the population over 10 years, at £26,800/QALY gained.


CONCLUSIONS
Annual HIV testing of key populations in the UK is very cost-effective. Additional one-time testing of all other adults could identify the majority of undiagnosed PLHIV. These findings are potentially relevant to other low-prevalence, high-income countries.
UCLA Anderson School of Management, Los Angeles, California, United States of America.
Elisa F
EF
Long
Co-ordinating and Analytic Centre, National Prospective Monitoring System - HIV Health-economics Collaboration (NPMS-HHC CIC), London, United Kingdom.
Roshni
R
Mandalia
Co-ordinating and Analytic Centre, National Prospective Monitoring System - HIV Health-economics Collaboration (NPMS-HHC CIC), London, United Kingdom.
Sundhiya
S
Mandalia
Department of Management Science and Engineering, Stanford University, Stanford, California, United States of America.
Sabina S
SS
Alistar
Co-ordinating and Analytic Centre, National Prospective Monitoring System - HIV Health-economics Collaboration (NPMS-HHC CIC), London, United Kingdom; Health Services Research and Policy Department, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Eduard J
EJ
Beck
Department of Management Science and Engineering, Stanford University, Stanford, California, United States of America.
Margaret L
ML
Brandeau
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D019049:Developed Countries / Q000191:economics*; D005189:False Positive Reactions; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
D019380:Anti-HIV Agents