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The Cost and Cost-utility of Three Public Health HIV Case-finding Strategies: Evidence from Rhode Island, 2012–2014

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Abstract

To evaluate three testing strategies to identify new HIV diagnoses in Rhode Island (RI). RI deployed three testing strategies, by using rapid HIV tests at clinical settings, community-based organization (CBO) settings, and the Partner Notification Services (PNS) program from 2012 to 2014. We reviewed the rapid HIV test results and confirmatory test results to identify new diagnoses, and conducted a cost-utility analysis. The average cost per new diagnosis was $33,015 at CBO settings, $5446 at clinical settings, and $33,818 at the PNS program. The cost-utility analysis showed the state-wide program was cost-saving; testing was cost-saving at clinical settings, and cost-effective at CBO settings and the PNS program. Further analyses showed that cost-effectiveness varied widely across CBOs. The HIV testing expansion program in RI was cost-saving overall. The heterogeneity of cost-effectiveness across settings should provide guidance to officials for allocation of future resources to HIV testing.

Resumen

Evaluar la costo-efectividad de tres estrategias de pruebas de detección del VIH para identificar nuevos diagnósticos en Rhode Island (RI). Del 2012 al 2014, RI implementó tres estrategias de pruebas de detección del VIH, mediante el uso de pruebas rápidas: en espacios clínicos, a través de organizaciones con base comunitaria (CBO, por sus siglas en inglés) y el programa de notificación de parejas sexuales (PNS). Se realizó una revisión detallada de los costos y resultados de las pruebas rápidas del diagnóstico del VIH y las pruebas confirmatorias para identificar los nuevos diagnósticos, y se llevó a cabo un análisis de costo-utilidad. El costo promedio por nuevo diagnóstico fue de $33,015 en la configuración de CBO, $5446 en la configuración clínica y $33,818 en el programa PNS. El análisis de costo-utilidad mostró que el programa a nivel estatal era costo-ahorrador; las pruebas de detección del VIH eran costo-ahorradoras en los entornos clínicos, y costo-efectivas en la configuración de CBO y el programa PNS. Otros análisis mostraron que la costo-efectividad variaba ampliamente entre las organizaciones comunitarias. El programa de expansión de las pruebas de detección del VIH en RI resulta en un ahorro de costos en general. La heterogeneidad de la eficacia en función de los costos en cada contexto debe ayudar a orientar la asignación de recursos futuros para las pruebas de detección del VIH.

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Funding

This study was funded by the Rhode Island Department of Health through a Preventive Health and Health Services (PHHS) Block Grant from the Centers for Disease Control and Prevention (CDC).

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Authors and Affiliations

  1. Department of Health Services Research, Policy, and Practice, Brown University School of Public Health, South Main Street, Box G-S121-7, Providence, RI, 02903, USA

    Xinqi C. Li & Omar Galárraga

  2. Center for HIV/AIDS, STDs, Viral Hepatitis, and TB, Rhode Island Department of Health, 3 Capitol Hill, Providence, 02908, RI, USA

    Lillian Kusi, Theodore Marak, Thomas Bertrand & Philip A. Chan

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  1. Xinqi C. Li
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  2. Lillian Kusi
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  3. Theodore Marak
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  4. Thomas Bertrand
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  5. Philip A. Chan
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  6. Omar Galárraga
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Correspondence to Omar Galárraga.

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All coauthors declare no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Ms. Lillian Kusi was an employee with the stated affiliation at the time of project.

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Li, X.C., Kusi, L., Marak, T. et al. The Cost and Cost-utility of Three Public Health HIV Case-finding Strategies: Evidence from Rhode Island, 2012–2014. AIDS Behav 22, 3726–3733 (2018). https://doi.org/10.1007/s10461-017-1940-1

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  • DOI: https://doi.org/10.1007/s10461-017-1940-1

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