Routine HIV screening in France: clinical impact and cost-effectiveness

PLoS One. 2010 Oct 1;5(10):e13132. doi: 10.1371/journal.pone.0013132.

Abstract

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS Serodiagnosis / economics*
  • AIDS Serodiagnosis / statistics & numerical data
  • Adolescent
  • Adult
  • Aged
  • Anti-HIV Agents / therapeutic use
  • Cohort Studies
  • Cost-Benefit Analysis*
  • Female
  • France / epidemiology
  • HIV Infections / diagnosis*
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology
  • HIV Infections / transmission
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Prevalence
  • Quality of Life
  • Sensitivity and Specificity

Substances

  • Anti-HIV Agents