|Titre :||Routine HIV screening in France: clinical impact and cost-effectiveness (2010)|
|Auteurs :||Y. YAZDANPANAH ; C. E. SLOAN ; C. CHARLOIS-OU ; C. SEMAILLE ; D. COSTAGLIOLA ; A. I. POULLIÉ ; O. SCEMAMA ; S. DEUFFIC-BURBAN ; E. LOSINA ; R. P. WALENSKY ; K. A. FREEDBERG ; A. D. PALTIEL|
|Type de document :||Article : Périodique|
|Dans :||PLOS ONE (Vol.5, n°10, October 2010)|
|Article en page(s) :||e13132, 9 p.|
|Discipline :||MAL (Maladies infectieuses / Infectious diseases)|
Thésaurus GéographiqueFRANCE ; GUYANE FRANCAISE
Thésaurus TOXIBASEEFFICACITE ; INJECTION ; VIH ; HSH ; USAGER ; PREVALENCE ; POPULATION GENERALE ; DEPISTAGE ; COUT
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 (€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 €50/person, for a cost-effectiveness ratio (CER) of €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 €51,200 and €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. [Author's abstract]
|Domaine :||Drogues illicites / Illicit drugs|
|Refs biblio. :||63|
|Affiliation :||Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, Tourcoing, France|