Title | Cost-effectiveness of Frequent HIV Screening Among High-risk Young Men Who Have Sex With Men in the United States. |
Publication Type | Publication |
Year of Publication | 2021 |
Authors | Neilan 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 |
Journal | Clin Infect Dis |
Volume | 73 |
Issue | 7 |
Pagination | e1927-e1935 |
Date Published | 2021 Oct 05 |
ISSN | 1537-6591 |
Keywords | Adolescent, Adult, CD4 Lymphocyte Count, Cost-Benefit Analysis, HIV Infections, Homosexuality, Male, Humans, Male, Quality-Adjusted Life Years, Sexual and Gender Minorities, United States, Young Adult |
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 ($2290-$3780), 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: $4500/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> |
DOI | 10.1093/cid/ciaa1061 |
Alternate Journal | Clin Infect Dis |
PubMed ID | 32730625 |
PubMed Central ID | PMC8492162 |
Grant List | U24 HD089880 / HD / NICHD NIH HHS / United States R01 MH105203 / MH / NIMH NIH HHS / United States U01 HD040474 / HD / NICHD NIH HHS / United States R37 AI093269 / AI / NIAID NIH HHS / United States U01 HD040533 / NH / NIH HHS / United States R01 AI093269 / AI / NIAID NIH HHS / United States T32 AI007433 / AI / NIAID NIH HHS / United States P30 AI060354 / AI / NIAID NIH HHS / United States R37 DA015612 / DA / NIDA NIH HHS / United States T32 AI007433 / AI / NIAID NIH HHS / United States R01 AI042006 / AI / NIAID NIH HHS / United States UM1 AI068632 / AI / NIAID NIH HHS / United States R01 HD079214 / HD / NICHD NIH HHS / United States P30 MH058107 / MH / NIMH NIH HHS / United States P30 AI028697 / AI / NIAID NIH HHS / United States UL1 TR001881 / TR / NCATS NIH HHS / United States R01 DA015612 / DA / NIDA NIH HHS / United States K08 HD094638 / HD / NICHD NIH HHS / United States |