Routine HIV Screening in Portugal: Clinical Impact and Cost-Effectiveness: e84173

• Published in: PloS one 2013-12, Vol.8 (12)
• Main Authors: Yazdanpanah, Yazdan, Perelman, Julian, DiLorenzo, Madeline A, Alves, Joana, Barros, Henrique, Mateus, Ceu, Pereira, Joao, Mansinho, Kamal, Robine, Marion, Park, Ji-Eun
• Format: Article
• Language: English
• ISSN: 1932-6203
• DOI: 10.1371/journal.pone.0084173

Objective To compare the clinical outcomes and cost-effectiveness of routine HIV screening in Portugal to the current practice of targeted and on-demand screening. Design We used Portuguese national clinical and economic data to conduct a model-based assessment. Methods We compared current HIV detection practices to strategies of increasingly frequent routine HIV screening in Portuguese adults aged 18-69. We considered several subpopulations and geographic regions with varying levels of undetected HIV prevalence and incidence. Baseline inputs for the national case included undiagnosed HIV prevalence 0.16%, annual incidence 0.03%, mean population age 43 years, mean CD4 count at care initiation 292 cells/ mu L, 63% HIV test acceptance, 78% linkage to care, and HIV rapid test cost [Euro6 under the proposed routine screening program. Outcomes included quality-adjusted survival, secondary HIV transmission, cost, and incremental cost-effectiveness. Results One-time national HIV screening increased HIV-infected survival from 164.09 quality-adjusted life months (QALMs) to 166.83 QALMs compared to current practice and had an incremental cost-effectiveness ratio (ICER) of [Euro28,000 per quality-adjusted life year (QALY). Screening more frequently in higher-risk groups was cost-effective: for example screening annually in men who have sex with men or screening every three years in regions with higher incidence and prevalence produced ICERs of [Euro21,000/QALY and [Euro34,000/QALY, respectively. Conclusions One-time HIV screening in the Portuguese national population will increase survival and is cost-effective by international standards. More frequent screening in higher-risk regions and subpopulations is also justified. Given Portugal's challenging economic priorities, we recommend prioritizing screening in higher-risk populations and geographic settings.