The Cost-Effectiveness of Symptom-Based Testing and Routine Screening for Acute HIV Infection in Men Who Have Sex with Men in the United States.

Published: June 29, 2011

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 US.

DESIGN:

Dynamic model of HIV transmission and progression.

INTERVENTIONS:

We evaluated three testing approaches: viral load (VL) testing for individuals with ILI, expanded screening with antibody testing, and expanded screening with antibody and VL testing. We included treatment with antiretroviral therapy for individuals identified as acutely infected.

MAIN OUTCOME MEASURES:

New HIV infections, discounted 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 $12,582 per QALY gained. Symptom-based VL testing with ILI is more expensive than expanded antibody screening, but is more effective and costs $22,786 per QALY gained. Combining expanded antibody screening with symptom-based VL testing prevents twice as many infections compared to expanded antibody screening alone, and costs $29,923 per QALY gained. Adding VL testing to all annual HIV tests costs more than $100,000 per QALY gained.

CONCLUSIONS:

Use of HIV VL 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 VL testing in MSM, in addition to encouraging annual antibody screening.

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