Cost-effectiveness of frequent HIV screening among high-risk young men who have sex with men in the United States.

TitleCost-effectiveness of frequent HIV screening among high-risk young men who have sex with men in the United States.
Publication TypePublication
Year of Publication2020
AuthorsNeilan AM, Bulteel AJB, Hosek SG, Foote JHA, Freedberg KA, Landovitz RJ, Walensky RP, Resch SC, Kazemian P, A Paltiel D, Weinstein MC, Wilson CM, Ciaranello AL
JournalClin Infect Dis
Date Published2020 Jul 30
ISSN1537-6591
Abstract

<p><b>BACKGROUND: </b>Of new HIV infections in the US, 20% occur among young men who have sex with men (YMSM, ages 13-24), but >50% of YMSM with HIV are unaware of their status. Using Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) data, we projected the clinical benefit and cost-effectiveness of frequent HIV screening among high-risk YMSM from age 15.</p><p><b>METHODS: </b>Using a mathematical simulation, we examined 3 screening strategies: Yearly, 6-monthly, and 3-monthly, each in addition to the Status quo (SQ, 0.7-10.3% screened/year, stratified by age). We used published data (YMSM-specific when available) including: HIV incidences (0.91-6.41/100PY); screen acceptance (80%), linkage-to-care/antiretroviral therapy (ART) initiation (76%), HIV transmission (0.3-86.1/100PY, by HIV RNA), monthly ART costs ($2,290-$3,780), and HIV per-screen costs ($38). Projected outcomes included CD4 count at diagnosis, primary HIV transmissions from ages 15-30, quality-adjusted life expectancy, costs, and incremental cost-effectiveness ratios (ICERs, $/quality-adjusted life-year saved [QALY]; threshold ≤$100,000/QALY).</p><p><b>RESULTS: </b>Compared to SQ, all strategies increased projected CD4 at diagnosis (296 to 477-515 cells/µL) and quality-adjusted life expectancy from age 15 (44.4 to 48.3-48.7 years) among YMSM acquiring HIV. Compared to SQ, all strategies increased discounted lifetime cost for the entire population ($170,800 to $178,100-$185,000/person). Screening 3-monthly was cost-effective (ICER: $4,500/QALY) compared to SQ and reduced primary transmissions through age 30 by 40%. Results were most sensitive to transmission rates; excluding the impact of transmissions, screening Yearly was ≤$100,000/QALY (ICER: $70,900/QALY).</p><p><b>CONCLUSIONS: </b>For high-risk YMSM in the US, HIV screening 3-monthly compared to less frequent screening will improve clinical outcomes and be cost-effective.</p>

DOI10.1093/cid/ciaa1061
Alternate JournalClin Infect Dis
PubMed ID32730625
Grant ListU24 HD089880 / HD / NICHD NIH HHS / United States
R01 AI042006 / AI / NIAID NIH HHS / United States
R01 HD079214 / HD / NICHD NIH HHS / United States
R37 AI093269 / AI / NIAID NIH HHS / United States
T32 AI007433 / AI / NIAID NIH HHS / United States
K08 HD094638 / HD / NICHD NIH HHS / United States
R37 DA015612 / DA / NIDA NIH HHS / United States