Cost-Effectiveness of Pooled Nucleic Acid Amplification Testing for Acute HIV Infection after Third-Generation HIV Antibody Screening and Rapid Testing in the United States: A Comparison of Three Public Health Settings

English version České info

Background:
Detection of acute HIV infection (AHI) with pooled nucleic acid amplification testing (NAAT) following HIV testing is feasible. However, cost-effectiveness analyses to guide policy around AHI screening are lacking; particularly after more sensitive third-generation antibody screening and rapid testing.

Methods and Findings:
We conducted a cost-effectiveness analysis of pooled NAAT screening that assessed the prevention benefits of identification and notification of persons with AHI and cases averted compared with repeat antibody testing at different intervals. Effectiveness data were derived from a Centers for Disease Control and Prevention AHI study conducted in three settings: municipal sexually transmitted disease (STD) clinics, a community clinic serving a population of men who have sex with men, and HIV counseling and testing sites. Our analysis included a micro-costing study of NAAT and a mathematical model of HIV transmission. Cost-effectiveness ratios are reported as costs per quality-adjusted life year (QALY) gained in US dollars from the societal perspective. Sensitivity analyses were conducted on key variables, including AHI positivity rates, antibody testing frequency, symptomatic detection of AHI, and costs. Pooled NAAT for AHI screening following annual antibody testing had cost-effectiveness ratios exceeding US$200,000 per QALY gained for the municipal STD clinics and HIV counseling and testing sites and was cost saving for the community clinic. Cost-effectiveness ratios increased substantially if the antibody testing interval decreased to every 6 months and decreased to cost-saving if the testing interval increased to every 5 years. NAAT was cost saving in the community clinic in all situations. Results were particularly sensitive to AHI screening yield.

Conclusions:
Pooled NAAT screening for AHI following negative third-generation antibody or rapid tests is not cost-effective at recommended antibody testing intervals for high-risk persons except in very high-incidence settings.

: Please see later in the article for the Editors' Summary

Vyšlo v časopise: Cost-Effectiveness of Pooled Nucleic Acid Amplification Testing for Acute HIV Infection after Third-Generation HIV Antibody Screening and Rapid Testing in the United States: A Comparison of Three Public Health Settings. PLoS Med 7(9): e32767. doi:10.1371/journal.pmed.1000342
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1000342

Souhrn

Zdroje

1. QuinnTC

1997 Acute primary HIV infection. JAMA 278 58 62

2. WestreichDJ

HudgensMG

FiscusSA

PilcherCD

2008 Optimizing screening for acute human immunodeficiency virus infection with pooled nucleic acid amplification tests. J Clin Microbiol 46 1785 1792

3. StramerSL

GlynnSA

KleinmanSH

StrongDM

CagliotiS

2004 Detection of HIV-1 and HCV infections among antibody-negative blood donors by nucleic acid-amplification testing. N Engl J Med 351 760 768

4. PilcherCD

McPhersonJT

LeonePA

SmurzynskiM

Owen-O'DowdJ

2002 Real-time, universal screening for acute HIV infection in a routine HIV counseling and testing population. JAMA 288 216 221

5. PatelP

KlausnerJD

BaconOM

LiskaS

TaylorM

2006 Detection of acute HIV infections in high-risk patients in California. J Acquir Immune Defic Syndr 42 75 79

6. TruongHM

GrantRM

McFarlandW

KelloggT

KentC

2006 Routine surveillance for the detection of acute and recent HIV infections and transmission of antiretroviral resistance. AIDS 20 2193 2197

7. PriddyFH

PilcherCD

MooreRH

TambeP

ParkMN

2007 Detection of acute HIV infections in an urban HIV counseling and testing population in the United States. J Acquir Immune Defic Syndr 44 196 202

8. HelmsDJ

WeinstockHS

MahleKC

BernsteinKT

FurnessBW

2009 HIV testing frequency among men who have sex with men attending sexually transmitted disease clinics: implications for HIV prevention and surveillance. J Acquir Immune Defic Syndr 50 320 326

9. MillerWC

LeonePA

McCoyS

NguyenTQ

WilliamsDE

2009 Targeted testing for acute HIV infection in North Carolina. AIDS 23 835 843

10. OwenSM

YangC

SpiraT

OuCY

PauCP

2008 Alternative algorithms for human immunodeficiency virus infection diagnosis using tests that are licensed in the United States. J Clin Microbiol 46 1588 1595

11. LouieB

WongE

KlausnerJD

LiskaS

HechtF

2008 Assessment of rapid tests for detection of human immunodeficiency virus-specific antibodies in recently infected individuals. J Clin Microbiol 46 1494 1497

12. HutchinsonAB

BransonBM

KimA

FarnhamPG

2006 A meta-analysis of the effectiveness of alternative HIV counseling and testing methods to increase knowledge of HIV status. AIDS 20 1597 1604

13. KellyJA

MorinSF

RemienRH

StewardWT

HigginsJA

2009 Lessons learned about behavioral science and acute/early HIV infection. The NIMH Multisite Acute HIV Infection Study: V. AIDS Behav 13 1068 1074

14. SteklerJD

SwensonPD

CoombsRW

DragavonJ

ThomasKK

2009 HIV testing in a high-incidence population: is antibody testing alone good enough? Clin Infect Dis 49 444 453

15. PatelP

MackellarD

SimmonsP

UniyalA

GallagherK

2010 Detecting acute human immunodeficiency virus infection using 3 different screening immunoassays and nucleic acid amplification testing for human immunodeficiency virus RNA, 2006-2008. Arch Intern Med 170 66 74

16. GoldMR

1996 Cost-effectiveness in health and medicine. New York Oxford University Press. xxiii, 425 p

17. Panel on Antiretroviral Guidelines for Adults and Adolescents 2008 Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents.:1-139. Available: http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf. Accessed 16 April 2009

18. FagardC

OxeniusA

GunthardH

GarciaF

Le BrazM

2003 A prospective trial of structured treatment interruptions in human immunodeficiency virus infection. Arch Intern Med 163 1220 1226

19. FauciAS

PantaleoG

StanleyS

WeissmanD

1996 Immunopathogenic mechanisms of HIV infection. Ann Intern Med 124 654 663

20. SchackmanBR

GeboKA

WalenskyRP

LosinaE

MuccioT

2006 The lifetime cost of current human immunodeficiency virus care in the United States. Med Care 44 990 997

21. MarksG

CrepazN

JanssenRS

2006 Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS 20 1447 1450

22. MarksG

CrepazN

SenterfittJW

JanssenRS

2005 Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr 39 446 453

23. HallHI

SongR

RhodesP

PrejeanJ

AnQ

2008 Estimation of HIV incidence in the United States. JAMA 300 520 529

24. BransonBM

HandsfieldHH

LampeMA

JanssenRS

TaylorAW

2006 Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep 55: 1-17; quiz CE11-14

25. Golden MRWR

2005 STD/HIV screening guidelines for men who have sex with men (MSM). Seattle (Washington) Public Health-Seattle and King County

26. Prevention CfDCa 2001 Revised guidelines for HIV counseling, testing, and referral. MMWR Recomm Rep 50 1 57; quiz CE51-19a51-CE56-19a51

27. ZetolaNM

PilcherCD

2007 Diagnosis and management of acute HIV infection. Infect Dis Clin North Am 21 19 48, vii

28. SchackerT

CollierAC

HughesJ

SheaT

CoreyL

1996 Clinical and epidemiologic features of primary HIV infection. Ann Intern Med 125 257 264

29. WeintrobAC

GinerJ

MenezesP

PatrickE

BenjaminDKJr

2003 Infrequent diagnosis of primary human immunodeficiency virus infection: missed opportunities in acute care settings. Arch Intern Med 163 2097 2100

30. TengsTO

LinTH

2002 A meta-analysis of utility estimates for HIV/AIDS. Med Decis Making 22 475 481

31. KungHC

HoyertDL

XuJ

MurphySL

2008 Deaths: final data for 2005. Natl Vital Stat Rep 56 1 120

32. SteklerJ

SwensonPD

WoodRW

HandsfieldHH

GoldenMR

2005 Targeted screening for primary HIV infection through pooled HIV-RNA testing in men who have sex with men. AIDS 19 1323 1325

33. BraithwaiteRS

MeltzerDO

KingJTJr

LeslieD

RobertsMS

2008 What does the value of modern medicine say about the $50,000 per quality-adjusted life-year decision rule? Med Care 46 349 356

34. UbelPA

HirthRA

ChernewME

FendrickAM

2003 What is the price of life and why doesn't it increase at the rate of inflation? Arch Intern Med 163 1637 1641

35. Hightow-WeidmanLB

GolinCE

GreenK

ShawEN

MacDonaldPD

2009 Identifying people with acute HIV infection: demographic features, risk factors, and use of health care among individuals with AHI in North Carolina. AIDS Behav 13 1075 1083

36. CDC 2009 Acute HIV infection - New York City, 2008. MMWR Morb Mortal Wkly Rep 58 1296 1299

37. Sullivan TJPM

EthridgeSF

PatelP

2010 An evaluation of pooling strategies for acute HIV-1 infection screening using nucleic acid amplification testing [poster]. Proceedings of the 2010 HIV Diagnostics Conference; 24–26 March 2010; Orlando, Florida,United States. Poster 28. Available: http://www.hivtestingconference.org/posters.html

38. SandersGD

BayoumiAM

SundaramV

BilirSP

NeukermansCP

2005 Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy. N Engl J Med 352 570 585

39. JacksonBR

BuschMP

StramerSL

AuBuchonJP

2003 The cost-effectiveness of NAT for HIV, HCV, and HBV in whole-blood donations. Transfusion 43 721 729

40. MarshallDA

KleinmanSH

WongJB

AuBuchonJP

GrimaDT

2004 Cost-effectiveness of nucleic acid test screening of volunteer blood donations for hepatitis B, hepatitis C and human immunodeficiency virus in the United States. Vox Sang 86 28 40

41. HutchinsonAB

FergussonD

GrahamID

LaupacisA

HerrinJ

2001 Utilization of technologies to reduce allogeneic blood transfusion in the United States. Transfus Med 11 79 85

42. Yeh JMBM

PashosCL

PostmaMJ

StaginnusU

2002 Economics of transfusion. Transfus Med Hemother 29 218 225

43. PaltielAD

WeinsteinMC

KimmelAD

SeageGR3rd

LosinaE

2005 Expanded screening for HIV in the United States—an analysis of cost-effectiveness. N Engl J Med 352 586 595

44. Internal Revenue Service 2008 IRS increases mileage rates through Dec. 31, 2008. Available: http://www.irs.gov/newsroom/article/0,,id=184163,00.htm. Accessed 12 May 2009

45. FarnhamPG

HutchinsonAB

SansomSL

BransonBM

2008 Comparing the costs of HIV screening strategies and technologies in health-care settings. Public Health Rep 123 Suppl 3 51 62

46. Centers for Medicare and Medicaid Services 2008 Clinical diagnostic laboratory fee schedule 2008. Available: http://www.cms.hhs.gov/ClinicalLabFeeSched/01_overview.asp. Accessed 13 May 2009

47. PrabhuVS

HutchinsonAB

FarnhamPG

SansomSL

2009 Sexually acquired HIV infections in the United States due to acute-phase HIV transmission: an update. AIDS 23 1792 1794

48. ZaricGS

BarnettPG

BrandeauML

2000 HIV transmission and the cost-effectiveness of methadone maintenance. Am J Public Health 90 1100 1111