Clinical effect and cost-effectiveness of incorporation of point-of-care assays into early infant HIV diagnosis programmes in Zimbabwe: a modelling study

Publication date: Available online 5 February 2019Source: The Lancet HIVAuthor(s): Simone C Frank, Jennifer Cohn, Lorna Dunning, Emma Sacks, Rochelle P Walensky, Sushant Mukherjee, Caitlin M Dugdale, Esther Turunga, Kenneth A Freedberg, Andrea L CiaranelloSummaryBackgroundNew point-of-care (POC) assays for early infant HIV diagnosis are costlier than conventional total nucleic acid assays, but could increase access to testing, shorten time to results, and expedite initiation of antiretroviral therapy. We aimed to assess the clinical benefits and cost-effectiveness of incorporating these POC assays into early infant diagnosis programmes in Zimbabwe.MethodsWe used the Cost Effectiveness of Preventing AIDS Complications (CEPAC)—Pediatric model to examine the clinical benefits, costs, and cost-effectiveness of replacing conventional assays for early infant HIV diagnosis with POC assays at age 6 weeks in Zimbabwe. We simulated two strategies for early infant HIV diagnosis: conventional and POC. Modelled assays differed in sensitivity; specificity; time to, and probability of, return of results; and cost. Model outcomes included survival, life expectancy, and mean lifetime per-person treatment cost, which were reported separately for all HIV-exposed infants and all infants with HIV. We calculated incremental cost-effectiveness ratios with discounted (3% per year) costs and life expectancy from a health-care system perspective for all HIV-exposed infants. We judged incremental cos...
Source: The Lancet HIV - Category: Infectious Diseases Source Type: research