Economic evaluation of alternative testing regimes and settings to detect undiagnosed HIV in Australia

Williams, Owain D. and Dean, Judith A. and Crothers, Anna and Gilks, Charles F. and Gow, Jeff (2021) Economic evaluation of alternative testing regimes and settings to detect undiagnosed HIV in Australia. BMC Health Services Research, 21:30. pp. 1-12.

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Abstract

Background
The study aimed to estimate the comparative costs per positive diagnosis of previously undetected HIV in three testing regimes: conventional; parallel and point of care (POC) testing. The regimes are analysed in six testing settings in Australia where infection is concentrated but with low prevalence.

Methods
A cost model was developed to highlight the trade-offs between test and economic efficiency from a provider perspective. First, an estimate of the number of tests needed to find a true (previously undiagnosed) positive diagnosis was made. Second, estimates of the average cost per positive diagnosis in whole of population (WoP) and men who have sex with men (MSM) was made, then third, aggregated to the total cost for diagnosis of all undetected infections.

Results
Parallel testing is as effective as conventional testing, but more economically efficient. POC testing provide two significant advantages over conventional testing: they screen out negatives effectively at comparatively lower cost and, with confirmatory testing of reactive results, there is no loss in efficiency. The average and total costs per detection in WoP are prohibitive, except for Home Self Testing. The diagnosis in MSM is cost effective in all settings, but especially using Home Self Testing when the individual assumes the cost of testing.

Conclusions
This study illustrates the trade-offs between economic and test efficiency and their interactions with population(s) prevalence. The efficient testing regimes and settings are presently under or not funded in Australia. Home Self Testing has the potential to dramatically increase testing rates at very little cost.


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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Faculty/School / Institute/Centre: Historic - Faculty of Business, Education, Law and Arts - School of Commerce (1 Jul 2013 - 17 Jan 2021)
Faculty/School / Institute/Centre: Current - Institute for Resilient Regions - Centre for Health Research (1 Apr 2020 -)
Date Deposited: 14 Jan 2021 06:45
Last Modified: 14 Jan 2021 06:45
Uncontrolled Keywords: HIV testing, Conventional testing, Parallel testing, Point of care testing, Self-testing, Costs
Fields of Research (2008): 11 Medical and Health Sciences > 1117 Public Health and Health Services > 111799 Public Health and Health Services not elsewhere classified
14 Economics > 1402 Applied Economics > 140208 Health Economics
Fields of Research (2020): 38 ECONOMICS > 3801 Applied economics > 380108 Health economics
42 HEALTH SCIENCES > 4206 Public health > 420699 Public health not elsewhere classified
Socio-Economic Objectives (2008): C Society > 92 Health > 9205 Specific Population Health (excl. Indigenous Health) > 920504 Men's Health
C Society > 92 Health > 9202 Health and Support Services > 920207 Health Policy Economic Outcomes
Socio-Economic Objectives (2020): 20 HEALTH > 2005 Specific population health (excl. Indigenous health) > 200504 Men's health
20 HEALTH > 2002 Evaluation of health and support services > 200206 Health system performance (incl. effectiveness of programs)
Funding Details:
Identification Number or DOI: https://doi.org/10.1186/s12913-020-06040-5
URI: http://eprints.usq.edu.au/id/eprint/40524

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