Cambiano V., Ford D., Mabugu T., Napierala Mavedzenge S., Miners A., Mugurungi O., Nakagawa F., Revill P., Phillips A.
Research Department of Infection and Population Health, Rowland Hill St, London, United Kingdom; MRC Clinical Trials Unit, University College London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom; Centre for Health Economics, University of York, United Kingdom; University of Zimbabwe Clinical Research Centre, Zimbabwe; Ministry of Health and Child Welfare Zimbabwe, Harare, Zimbabwe; Women's Global Health Imperative, RTI International, San Francisco, CA, United States
Cambiano, V., Research Department of Infection and Population Health, Rowland Hill St, London, United Kingdom; Ford, D., MRC Clinical Trials Unit, University College London, United Kingdom; Mabugu, T., University of Zimbabwe Clinical Research Centre, Zimbabwe; Napierala Mavedzenge, S., Women's Global Health Imperative, RTI International, San Francisco, CA, United States; Miners, A., Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, United Kingdom; Mugurungi, O., Ministry of Health and Child Welfare Zimbabwe, Harare, Zimbabwe; Nakagawa, F., Research Department of Infection and Population Health, Rowland Hill St, London, United Kingdom; Revill, P., Centre for Health Economics, University of York, United Kingdom; Phillips, A., Research Department of Infection and Population Health, Rowland Hill St, London, United Kingdom
Background. Studies have demonstrated that self-testing for human immunodeficiency virus (HIV) is highly acceptable among individuals and could allow cost savings, compared with provider-delivered HIV testing and counseling (PHTC), although the longer-term population-level effects are uncertain. We evaluated the cost-effectiveness of introducing self-testing in 2015 over a 20-year time frame in a country such as Zimbabwe. Methods. The HIV synthesis model was used. Two scenarios were considered. In the reference scenario, self-testing is not available, and the rate of first-time and repeat PHTC is assumed to increase from 2015 onward, in line with past trends. In the intervention scenario, self-testing is introduced at a unit cost of $3. Results. We predict that the introduction of self-testing would lead to modest savings in healthcare costs of $75 million, while averting around 7000 disability-adjusted life-years over 20 years. Findings were robust to most variations in assumptions; however, higher cost of self-testing, lower linkage to care for people whose diagnosis is a consequence of a positive self-test result, and lower threshold for antiretroviral therapy eligibility criteria could lead to situations in which self-testing is not cost-effective. Conclusions. This analysis suggests that introducing self-testing offers some health benefits and may well save costs. © 2015 The Author.
antiretrovirus agent; anti human immunodeficiency virus agent; adolescent; adult; aged; Article; controlled study; cost benefit analysis; cost control; cost effectiveness analysis; diagnostic test; diagnostic test accuracy study; disability; epidemic; health care cost; health care personnel; HIV test; human; human cell; Human immunodeficiency virus; Human immunodeficiency virus infection; Human immunodeficiency virus prevalence; intermethod comparison; nonhuman; patient care; patient counseling; prediction; priority journal; provider-delivered HIV testing and counseling; repeat procedure; self evaluation; sensitivity and specificity; trend study; Zimbabwe; biological model; developing country; economics; health; HIV Infections; poverty; prevalence; self care; statistics; time; Anti-HIV Agents; Cost-Benefit Analysis; Developing Countries; Global Health; HIV Infections; Humans; Models, Biological; Poverty; Prevalence; Self Care; Stochastic Processes; Time Factors; Zimbabwe