期刊
PLOS ONE
卷 5, 期 10, 页码 -出版社
PUBLIC LIBRARY SCIENCE
DOI: 10.1371/journal.pone.0013132
关键词
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资金
- Haute Autorite de Sante
- Institut de Veille Sanitaire, Sidaction
- Agence Nationale de Recherches sur le SIDA et les hepatites virales
- National Institute of Allergy and Infectious Diseases [R01 AI042006, K24 AI062476, P30 AI42851]
- National Institute of Mental Health [R01 MH65869]
- National Institute on Drug Abuse [R01 DA015612]
- Boehringer-Ingelheim
- Bristol-Myers Squibb
- Gilead Sciences
- GlaxoSmithKline
- Merck-Sharp Dohme-Chibret
- Pfizer
- Roche
- Schering Plough
- Tibotec
- Abbott
- Janssen-Cilag
Background: In France, roughly 40,000 HIV-infected persons are unaware of their HIV infection. Although previous studies have evaluated the cost-effectiveness of routine HIV screening in the United States, differences in both the epidemiology of infection and HIV testing behaviors warrant a setting-specific analysis for France. Methods/Principal Findings: We estimated the life expectancy (LE), cost and cost-effectiveness of alternative HIV screening strategies in the French general population and high-risk sub-populations using a computer model of HIV detection and treatment, coupled with French national clinical and economic data. We compared risk-factor-based HIV testing (current practice'') to universal routine, voluntary HIV screening in adults aged 18-69. Screening frequencies ranged from once to annually. Input data included mean age (42 years), undiagnosed HIV prevalence (0.10%), annual HIV incidence (0.01%), test acceptance (79%), linkage to care (75%) and cost/test ((sic)43). We performed sensitivity analyses on HIV prevalence and incidence, cost estimates, and the transmission benefits of ART. Current practice'' produced LEs of 242.82 quality-adjusted life months (QALM) among HIV-infected persons and 268.77 QALM in the general population. Adding a one-time HIV screen increased LE by 0.01 QALM in the general population and increased costs by (sic)50/person, for a cost-effectiveness ratio (CER) of (sic)57,400 per quality-adjusted life year (QALY). More frequent screening in the general population increased survival, costs and CERs. Among injection drug users (prevalence 6.17%; incidence 0.17%/year) and in French Guyana (prevalence 0.41%; incidence 0.35%/year), annual screening compared to every five years produced CERs of (sic)51,200 and (sic)46,500/QALY. Conclusions/Significance: One-time routine HIV screening in France improves survival compared to current practice'' and compares favorably to other screening interventions recommended in Western Europe. In higher-risk groups, more frequent screening is economically justifiable.
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