HIV screening is cost-effective in Russia
Research Activities, September 2009
The HIV epidemic is growing fast in Russia, driven by drug use and the commercial sex trade. More than 1 million people are estimated to be infected, with 80 percent of actual HIV cases under 30 years of age. While screening for HIV is widely available, little is known about just how cost-effective it really is. Now, a new study shows that such early detection and treatment of HIV in Russia is cost-effective and results in substantial benefits in life expectancy. Using epidemiologic and economic data, researchers developed a model to estimate costs, quality of life, and survival associated with HIV screening. Their model followed individuals aged 15 to 49 years old over their lifetimes. Three screening approaches were evaluated: no HIV screening, once-per-lifetime HIV screening, and repeat HIV screening.
Early diagnosis of HIV as a result of screening produced a substantial gain of 2.1 years in life expectancy and 1.7 years in quality-adjusted life years (QALY). These gains are similar to those found in the United States through screening. One-time HIV screening was cost-effective with costs of $56 more per person screened than HIV diagnosis based on symptoms alone. One-time screening cost $13,396 per QALY gained, at a base-case prevalence of 1.2 percent. This continued to be the case even when the prevalence of HIV dipped as low as 0.04 percent. Repeat screening was cost-effective when conducted as frequently as every 2 years. It was most cost-effective for individuals from high-incidence risk groups, who could benefit from annual screenings. However, the cost-effectiveness of screening depended on effective risk-reduction counseling (20 percent reduction in risky sexual behavior) and giving individuals some access to HIV medications.
Since HIV testing is so inexpensive in Russia, even modestly effective counseling for risk reduction and less-than-universal access to HIV medications still make screening cost-effective in the country, note the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS00028).
See "Cost-effectiveness of voluntary HIV screening in Russia," by Swati P. Tole, M.D., M.S., Gillian D. Sanders, Ph.D., Ahmed M. Bayoumi, M.D., M.Sc., and others in the January 2009 International Journal of STD and AIDS 20, pp. 46-51.