dc.contributor.author | Hyle, Emily P. | en_US |
dc.contributor.author | Jani, Ilesh V. | en_US |
dc.contributor.author | Lehe, Jonathan | en_US |
dc.contributor.author | Su, Amanda E. | en_US |
dc.contributor.author | Wood, Robin | en_US |
dc.contributor.author | Quevedo, Jorge | en_US |
dc.contributor.author | Losina, Elena | en_US |
dc.contributor.author | Bassett, Ingrid V. | en_US |
dc.contributor.author | Pei, Pamela P. | en_US |
dc.contributor.author | Paltiel, A. David | en_US |
dc.contributor.author | Resch, Stephen | en_US |
dc.contributor.author | Freedberg, Kenneth A. | en_US |
dc.contributor.author | Peter, Trevor | en_US |
dc.contributor.author | Walensky, Rochelle P. | en_US |
dc.date.accessioned | 2014-10-01T14:27:52Z | |
dc.date.issued | 2014 | en_US |
dc.identifier.citation | Hyle, E. P., I. V. Jani, J. Lehe, A. E. Su, R. Wood, J. Quevedo, E. Losina, et al. 2014. “The Clinical and Economic Impact of Point-of-Care CD4 Testing in Mozambique and Other Resource-Limited Settings: A Cost-Effectiveness Analysis.” PLoS Medicine 11 (9): e1001725. doi:10.1371/journal.pmed.1001725. http://dx.doi.org/10.1371/journal.pmed.1001725. | en |
dc.identifier.issn | 1549-1277 | en |
dc.identifier.uri | http://nrs.harvard.edu/urn-3:HUL.InstRepos:12987248 | |
dc.description.abstract | Background: Point-of-care CD4 tests at HIV diagnosis could improve linkage to care in resource-limited settings. Our objective is to evaluate the clinical and economic impact of point-of-care CD4 tests compared to laboratory-based tests in Mozambique. Methods and Findings: We use a validated model of HIV testing, linkage, and treatment (CEPAC-International) to examine two strategies of immunological staging in Mozambique: (1) laboratory-based CD4 testing (LAB-CD4) and (2) point-of-care CD4 testing (POC-CD4). Model outcomes include 5-y survival, life expectancy, lifetime costs, and incremental cost-effectiveness ratios (ICERs). Input parameters include linkage to care (LAB-CD4, 34%; POC-CD4, 61%), probability of correctly detecting antiretroviral therapy (ART) eligibility (sensitivity: LAB-CD4, 100%; POC-CD4, 90%) or ART ineligibility (specificity: LAB-CD4, 100%; POC-CD4, 85%), and test cost (LAB-CD4, US$10; POC-CD4, US$24). In sensitivity analyses, we vary POC-CD4-specific parameters, as well as cohort and setting parameters to reflect a range of scenarios in sub-Saharan Africa. We consider ICERs less than three times the per capita gross domestic product in Mozambique (US$570) to be cost-effective, and ICERs less than one times the per capita gross domestic product in Mozambique to be very cost-effective. Projected 5-y survival in HIV-infected persons with LAB-CD4 is 60.9% (95% CI, 60.9%–61.0%), increasing to 65.0% (95% CI, 64.9%–65.1%) with POC-CD4. Discounted life expectancy and per person lifetime costs with LAB-CD4 are 9.6 y (95% CI, 9.6–9.6 y) and US$2,440 (95% CI, US$2,440–US$2,450) and increase with POC-CD4 to 10.3 y (95% CI, 10.3–10.3 y) and US$2,800 (95% CI, US$2,790–US$2,800); the ICER of POC-CD4 compared to LAB-CD4 is US$500/year of life saved (YLS) (95% CI, US$480–US$520/YLS). POC-CD4 improves clinical outcomes and remains near the very cost-effective threshold in sensitivity analyses, even if point-of-care CD4 tests have lower sensitivity/specificity and higher cost than published values. In other resource-limited settings with fewer opportunities to access care, POC-CD4 has a greater impact on clinical outcomes and remains cost-effective compared to LAB-CD4. Limitations of the analysis include the uncertainty around input parameters, which is examined in sensitivity analyses. The potential added benefits due to decreased transmission are excluded; their inclusion would likely further increase the value of POC-CD4 compared to LAB-CD4. Conclusions: POC-CD4 at the time of HIV diagnosis could improve survival and be cost-effective compared to LAB-CD4 in Mozambique, if it improves linkage to care. POC-CD4 could have the greatest impact on mortality in settings where resources for HIV testing and linkage are most limited. Please see later in the article for the Editors' Summary | en |
dc.language.iso | en_US | en |
dc.publisher | Public Library of Science | en |
dc.relation.isversionof | doi:10.1371/journal.pmed.1001725 | en |
dc.relation.hasversion | http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4165752/pdf/ | en |
dash.license | LAA | en_US |
dc.subject | Biology and Life Sciences | en |
dc.subject | Computational Biology | en |
dc.subject | Population Modeling | en |
dc.subject | Infectious Disease Modeling | en |
dc.subject | Medicine and health sciences | en |
dc.subject | Infectious diseases | en |
dc.subject | Viral diseases | en |
dc.subject | AIDS | en |
dc.subject | HIV infections | en |
dc.subject | Mathematical and Statistical Techniques | en |
dc.subject | Mathematical Models | en |
dc.subject | Social Sciences | en |
dc.subject | Economics | en |
dc.subject | Economic Analysis | en |
dc.subject | Cost-Effectiveness Analysis | en |
dc.title | The Clinical and Economic Impact of Point-of-Care CD4 Testing in Mozambique and Other Resource-Limited Settings: A Cost-Effectiveness Analysis | en |
dc.type | Journal Article | en_US |
dc.description.version | Version of Record | en |
dc.relation.journal | PLoS Medicine | en |
dash.depositing.author | Hyle, Emily P. | en_US |
dc.date.available | 2014-10-01T14:27:52Z | |
dc.identifier.doi | 10.1371/journal.pmed.1001725 | * |
dash.authorsordered | false | |
dash.contributor.affiliated | Resch, Stephen | |
dash.contributor.affiliated | Hyle, Emily | |
dash.contributor.affiliated | Bassett, Ingrid | |
dash.contributor.affiliated | Freedberg, Kenneth | |
dash.contributor.affiliated | Walensky, Rochelle | |
dash.contributor.affiliated | Losina, Elena | |