Cost-effectiveness of community-based human immunodeficiency virus self-testing in Blantyre, Malawi

Maheswaran, H., Clarke, A., MacPherson, P. , Kumwenda, F., Lalloo, D. G., Corbett, E. L. and Petrou, S. (2018) Cost-effectiveness of community-based human immunodeficiency virus self-testing in Blantyre, Malawi. Clinical Infectious Diseases, 66(8), pp. 1211-1221. (doi: 10.1093/cid/cix983) (PMID:29136117) (PMCID:PMC5889018)

Abstract

Background Human immunodeficiency virus self-testing (HIVST) is effective, with scale-up underway in sub-Saharan Africa. We assessed cost-effectiveness of adding HIVST to existing facility-based HIV testing and counseling (HTC) services. Both 2010 (initiate at CD4 <350 cells/μL) and 2015 (initiate all) World Health Organization (WHO) guidelines for antiretroviral treatment (ART) were considered. Methods A microsimulation model was developed to evaluate cost-effectiveness, from both health provider and societal perspectives, of an HIVST service implemented in a cluster-randomized trial (CRT; ISRCTN02004005) in Malawi. Costs and health outcomes were evaluated over a 20-year time horizon, using a discount rate of 3%. Probabilistic sensitivity analysis was conducted to account for parameter uncertainty. Results From the health provider perspective and 20-year time horizon, facility HTC using 2010 WHO ART guidelines was the least costly ($294.71 per person; 95% credible interval [CrI], 270.79–318.45) and least effective (11.64 quality-adjusted life-years [QALYs] per person; 95% CrI, 11.43–11.86) strategy. Compared with this strategy, the incremental cost-effectiveness ratio (ICER) for facility HTC using 2015 WHO ART guidelines was $226.85 (95% CrI, 198.79–284.35) per QALY gained. The strategy of facility HTC plus HIVST, using 2010 WHO ART guidelines, was extendedly dominated. The ICER for facility HTC plus HIVST, using 2015 WHO ART guidelines, was $253.90 (95% CrI, 201.71–342.02) per QALY gained compared with facility HTC and using 2015 WHO ART guidelines. Conclusions HIVST may be cost-effective in a Malawian population with high HIV prevalence. HIVST is suited to an early HIV diagnosis and treatment strategy.

• Item Type: Articles
• Additional Information: H. M. was supported by the Wellcome Trust (grant WT097973). E. L. C. was supported by the Wellcome Trust (grant WT091769). A. C. is supported by the NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) West Midlands initiative.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: MacPherson, Professor Peter
• Authors: Maheswaran, H., Clarke, A., MacPherson, P., Kumwenda, F., Lalloo, D. G., Corbett, E. L., and Petrou, S.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: Clinical Infectious Diseases
• Publisher: Oxford University Press
• ISSN: 1058-4838
• ISSN (Online): 1537-6591
• Published Online: 09 November 2017
• Copyright Holders: Copyright © The Author(s) 2017
• First Published: First published in Clinical Infectious Diseases 66(8):1211-1221
• Publisher Policy: Reproduced under a Creative Commons licence