Cost-effectiveness of voluntary HIV screening in Russia

Abstract

Objective and Methods Russia has one of the fastest growing HIV epidemics in the world, and screening has been widespread. Whether such screening is an effective use of resources is unclear. We used epidemiologic and economic data from Russia to develop a Markov model to estimate costs, quality of life, and survival associated with a voluntary HIV screening program compared to no screening in Russia. We measured discounted lifetime health care costs and quality-adjusted life years (QALYs) gained. We varied our inputs in sensitivity analysis. Results Early identification of HIV through screening provided a substantial benefit to persons with HIV, increasing life expectancy by 2.1 years and 1.7 QALYs. At a base-case prevalence of 1.2%, once-per-lifetime screening cost $13,396 per QALY gained, exclusive of benefit from reduced transmission. Cost-effectiveness of screening remained favorable until prevalence dropped below 0.04%. When HIV transmission-related costs and benefits were included, once-per-lifetime screening cost $6,910 per QALY gained, and screening every two years cost $27,696 per QALY gained. An important determinant of the cost-effectiveness of screening was effectiveness of counseling about risk reduction. Conclusions Early identification of HIV infection through screening in Russia is effective and cost-effective in all but the lowest prevalence groups.

The state of health economics and pharmaceoconomics research in Russia: a systematic review

“…Eight studies (50%) were cost studies and eight were economic evaluations, mostly cost‐effectiveness analyses ( n = 4). Three of the cost utility studies were not correctly labeled as such by the authors who labeled them as cost‐effectiveness analyses [4,44,47] . Economic analysis was the primary objective in 15 (93.8%) studies.…”

“…The earliest study was published in 1994 [48] and the latest were published in 2009 [6,38,44] . The highest number of articles was published in 2006 ( n = 4) [4,39,46,47] .…”

“…After reviewing the full articles, one article was excluded because it was not on Russia [35] and three were excluded because they were not original economic analyses. [1,36,37] The study's final sample consisted of 16 economic studies that satisfied our inclusion criteria ( Figure 1, Table 1 [4][5][6]9,[38][39][40][41][42][43][44][45][46][47][48][49] ).…”

“…Three of the cost utility studies were not correctly labeled as such by the authors who labeled them as cost-effectiveness analyses. [4,44,47] Economic analysis was the primary objective in 15 (93.8%) studies. Seven articles were on pharmaceuticals, three were on services, [42][43][44] three were on health technologies, [38,45,48] and three did not specify any primary health intervention.…”

“…[4,44,47] Economic analysis was the primary objective in 15 (93.8%) studies. Seven articles were on pharmaceuticals, three were on services, [42][43][44] three were on health technologies, [38,45,48] and three did not specify any primary health intervention. [9,40,41] Treatment (n = 8, 50%), and prevention and screening (n = 4, 25%) were the most investigated medical functions.…”