Cost-effectiveness of peer- versus venue-based approaches for detecting undiagnosed HIV among heterosexuals in high-risk New York City neighborhoods

Cost-effectiveness of peer- versus venue-based approaches for detecting undiagnosed HIV among heterosexuals in high-risk New York City neighborhoods. Stevens, E. R, Nucifora, K., Zhou, Q., Braithwaite, R. S., Cleland, C. M., Ritchie, A. S., Kutnick, A. H., & Gwadz, M. V Journal of acquired immune deficiency syndromes (1999), 77(2):183–192, February, 2018.

Paper doi abstract bibtex

Introduction We used a computer simulation of HIV progression and transmission to evaluate the cost-effectiveness of a scale-up of three strategies to seek out and test individuals with undiagnosed HIV in New York City (NYC). Setting Hypothetical NYC population Methods We incorporated the observed effects and costs of the three “seek and test” strategies in a computer simulation of HIV in NYC, comparing a scenario in which the strategies were scaled up with a one-year implementation or a long-term implementation with a counterfactual scenario with no scale-up. The simulation combined a deterministic compartmental model of HIV transmission with a stochastic microsimulation of HIV progression, calibrated to NYC epidemiological data from 2003 to 2015. The three approaches were respondent driven sampling (RDS) with anonymous HIV testing (“RDS-A”), RDS with a two-session confidential HIV testing approach (“RDS-C”), and venue-based sampling (“VBS”). Results RDS-A was the most cost-effective strategy tested. When implemented for only one year and then stopped thereafter, using a societal perspective, the cost per quality-adjusted life-year (QALY) gained versus no intervention was \$812/QALY, \$18,110/QALY, and \$20,362/QALY for RDS-A, RDS-C, and VBS, respectively. When interventions were implemented long-term, the cost per QALY gained versus no intervention was cost-saving, \$31,773/QALY, and \$35,148/QALY for RDS-A, RDS-C, and VBS, respectively. When compared to RDS-A the incremental cost effectiveness ratios (ICERs) for both VBS and RDS-C were dominated. Conclusion The expansion of the RDS-A strategy would substantially reduce HIV-related deaths and new HIV infections in NYC, and would be either cost-saving or have favorable cost-effectiveness.

@article{stevens_cost-effectiveness_2018,
	title = {Cost-effectiveness of peer- versus venue-based approaches for detecting undiagnosed {HIV} among heterosexuals in high-risk {New} {York} {City} neighborhoods},
	volume = {77},
	issn = {1525-4135},
	url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5762425/},
	doi = {10.1097/QAI.0000000000001578},
	abstract = {Introduction
We used a computer simulation of HIV progression and transmission to evaluate the cost-effectiveness of a scale-up of three strategies to seek out and test individuals with undiagnosed HIV in New York City (NYC).

Setting
Hypothetical NYC population

Methods
We incorporated the observed effects and costs of the three “seek and test” strategies in a computer simulation of HIV in NYC, comparing a scenario in which the strategies were scaled up with a one-year implementation or a long-term implementation with a counterfactual scenario with no scale-up. The simulation combined a deterministic compartmental model of HIV transmission with a stochastic microsimulation of HIV progression, calibrated to NYC epidemiological data from 2003 to 2015. The three approaches were respondent driven sampling (RDS) with anonymous HIV testing (“RDS-A”), RDS with a two-session confidential HIV testing approach (“RDS-C”), and venue-based sampling (“VBS”).

Results
RDS-A was the most cost-effective strategy tested. When implemented for only one year and then stopped thereafter, using a societal perspective, the cost per quality-adjusted life-year (QALY) gained versus no intervention was \$812/QALY, \$18,110/QALY, and \$20,362/QALY for RDS-A, RDS-C, and VBS, respectively. When interventions were implemented long-term, the cost per QALY gained versus no intervention was cost-saving, \$31,773/QALY, and \$35,148/QALY for RDS-A, RDS-C, and VBS, respectively. When compared to RDS-A the incremental cost effectiveness ratios (ICERs) for both VBS and RDS-C were dominated.

Conclusion
The expansion of the RDS-A strategy would substantially reduce HIV-related deaths and new HIV infections in NYC, and would be either cost-saving or have favorable cost-effectiveness.},
	number = {2},
	urldate = {2019-02-26},
	journal = {Journal of acquired immune deficiency syndromes (1999)},
	author = {Stevens, Elizabeth R and Nucifora, Kimberly and Zhou, Qinlian and Braithwaite, R. Scott and Cleland, Charles M. and Ritchie, Amanda S. and Kutnick, Alexandra H. and Gwadz, Marya V},
	month = feb,
	year = {2018},
	pmid = {29135654},
	pmcid = {PMC5762425},
	pages = {183--192}
}

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Setting Hypothetical NYC population Methods We incorporated the observed effects and costs of the three “seek and test” strategies in a computer simulation of HIV in NYC, comparing a scenario in which the strategies were scaled up with a one-year implementation or a long-term implementation with a counterfactual scenario with no scale-up. The simulation combined a deterministic compartmental model of HIV transmission with a stochastic microsimulation of HIV progression, calibrated to NYC epidemiological data from 2003 to 2015. The three approaches were respondent driven sampling (RDS) with anonymous HIV testing (“RDS-A”), RDS with a two-session confidential HIV testing approach (“RDS-C”), and venue-based sampling (“VBS”). Results RDS-A was the most cost-effective strategy tested. 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The simulation combined a deterministic compartmental model of HIV transmission with a stochastic microsimulation of HIV progression, calibrated to NYC epidemiological data from 2003 to 2015. The three approaches were respondent driven sampling (RDS) with anonymous HIV testing (“RDS-A”), RDS with a two-session confidential HIV testing approach (“RDS-C”), and venue-based sampling (“VBS”).\n\nResults\nRDS-A was the most cost-effective strategy tested. When implemented for only one year and then stopped thereafter, using a societal perspective, the cost per quality-adjusted life-year (QALY) gained versus no intervention was \\$812/QALY, \\$18,110/QALY, and \\$20,362/QALY for RDS-A, RDS-C, and VBS, respectively. When interventions were implemented long-term, the cost per QALY gained versus no intervention was cost-saving, \\$31,773/QALY, and \\$35,148/QALY for RDS-A, RDS-C, and VBS, respectively. 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