Costs along the service cascades for HIV testing and counselling and prevention of mother-to-child transmission

Bautista‐Arredondo, Sergio; Sosa-Rubí, Sandra G.; Opuni, Marjorie; Contreras-Loya, David; Kwan, Ada; Chaumont, Claire; Chompolola, Abson; Condo, Jeanine; Galárraga, Omar; Martinson, Neil; Masiye, Felix; Nsanzimana, Sabin; Ochoa-Moreno, Ivan; Wamai, Richard G.; Wang'ombe, Joseph

doi:10.1097/qad.0000000000001208

Cited by 27 publications

(40 citation statements)

References 28 publications

(20 reference statements)

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“…In this study, personnel costs were the key cost driver, which is similar to other studies , and can be attributed to the increased staff time spent on PMTCT tasks under Option B+. Start‐up costs and increased training provided under Option B+ also impacted on the cost of the Option B+ programme.…”

Section: Discussionsupporting

confidence: 84%

“…Divergent results were found between this study, where weighted average cost per woman treated under the Option A approach was US $525 (and US $826 under Option B+), and the higher estimates in empirical work by Bautista‐Arredondo et al . . They estimated the costs per woman under the Option A approach receiving medication in Kenya, South Africa and Zambia as ranging from US $704 to US $1385 (in 2013 US $), while in Rwanda the cost of Option B+ was estimated to be US $2214 per woman .…”

Section: Discussionmentioning

confidence: 99%

“…. They estimated the costs per woman under the Option A approach receiving medication in Kenya, South Africa and Zambia as ranging from US $704 to US $1385 (in 2013 US $), while in Rwanda the cost of Option B+ was estimated to be US $2214 per woman .…”

Section: Discussionmentioning

confidence: 99%

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Cost and cost‐effectiveness of transitioning to universal initiation of lifelong antiretroviral therapy for allHIV‐positive pregnant and breastfeeding women in Swaziland

Cunnama

Abrams

Myer

et al. 2018

Tropical Med Int Health

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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Cost and cost‐effectiveness of transitioning to universal initiation of lifelong antiretroviral therapy for allHIV‐positive pregnant and breastfeeding women in Swaziland

Cunnama

Abrams

Myer

et al. 2018

Tropical Med Int Health

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“…Our estimates for the cost‐per‐diagnosis did not vary substantially according to epidemiologic and programmatic characteristics and so appear to be generalizable to lower income countries in southern Africa, and likely elsewhere in sub‐Saharan Africa. This is a measure that is increasingly being reported by studies.…”

Section: Discussionmentioning

confidence: 99%

Cost‐per‐diagnosis as a metric for monitoring cost‐effectiveness of HIV testing programmes in low‐income settings in southern Africa: health economic and modelling analysis

Phillips¹,

Cambiano²,

Nakagawa³

et al. 2019

J Intern AIDS Soc

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Introduction As prevalence of undiagnosed HIV declines, it is unclear whether testing programmes will be cost‐effective. To guide their HIV testing programmes, countries require appropriate metrics that can be measured. The cost‐per‐diagnosis is potentially a useful metric. Methods We simulated a series of setting‐scenarios for adult HIV epidemics and ART programmes typical of settings in southern Africa using an individual‐based model and projected forward from 2018 under two policies: (i) a minimum package of “core” testing (i.e. testing in pregnant women, for diagnosis of symptoms, in sex workers, and in men coming forward for circumcision) is conducted, and (ii) core‐testing as above plus additional testing beyond this (“additional‐testing”), for which we specify different rates of testing and various degrees to which those with HIV are more likely to test than those without HIV. We also considered a plausible range of unit test costs. The aim was to assess the relationship between cost‐per‐diagnosis and the incremental cost‐effectiveness ratio (ICER) of the additional‐testing policy. The discount rate used in the base case was 3% per annum (costs in 2018 U.S. dollars). Results There was a strong graded relationship between the cost‐per‐diagnosis and the ICER. Overall, the ICER was below $500 per‐DALY‐averted (the cost‐effectiveness threshold used in primary analysis) so long as the cost‐per‐diagnosis was below $315. This threshold cost‐per‐diagnosis was similar according to epidemic and programmatic features including the prevalence of undiagnosed HIV, the HIV incidence and a measure of HIV programme quality (the proportion of HIV diagnosed people having a viral load <1000 copies/mL). However, restricting to women, additional‐testing did not appear cost‐effective even at a cost‐per‐diagnosis of below $50, while restricting to men additional‐testing was cost‐effective up to a cost‐per‐diagnosis of $585. The threshold cost per diagnosis for testing in men to be cost‐effective fell to $256 when the cost‐effectiveness threshold was $300 instead of $500, and to $81 when considering a discount rate of 10% per annum. Conclusions For testing programmes in low‐income settings in southern African there is an extremely strong relationship between the cost‐per‐diagnosis and the cost‐per‐DALY averted, indicating that the cost‐per‐diagnosis can be used to monitor the cost‐effectiveness of testing programmes.

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“…Costs per circumcision, per year on ART and of HIV testing were included and reflect comprehensive large scale costing studies conducted in Zambia 16–20. Costs were assumed to decrease according to the scale of production but increase at high coverage levels due to the need for outreach activities 21 22.…”

Section: Methodsmentioning

confidence: 99%

Appraising the value of evidence generation activities: an HIV modelling study

et al. 2018

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IntroductionThe generation of robust evidence has been emphasised as a priority for global health. Evidence generation spans a wide range of activities including clinical trials, surveillance programmes and health system performance measurement. As resources for healthcare and research are limited, the desirability of research expenditure should be assessed on the same basis as other healthcare resources, that is, the health gains from research must be expected to exceed the health opportunity costs imposed as funds are diverted to research rather than service provision.MethodsWe developed a transmission and costing model to examine the impact of generating additional evidence to reduce uncertainties on the evolution of a generalised HIV epidemic in Zambia.ResultsWe demonstrate three important points. First, we can quantify the value of additional evidence in terms of the health gain it is expected to generate. Second, we can quantify the health opportunity cost imposed by research expenditure. Third, the value of evidence generation depends on the budgetary policies in place for managing HIV resources under uncertainty. Generating evidence to reduce uncertainty is particularly valuable when decision makers are required to strictly adhere to expenditure plans and when transfers of funds across geographies/programmes are restricted.ConclusionBetter evidence can lead to health improvements in the same way as direct delivery of healthcare. Quantitative appraisals of evidence generation activities are important and should reflect the impact of improved evidence on population health, evidence generation costs and budgetary policies in place.

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Costs along the service cascades for HIV testing and counselling and prevention of mother-to-child transmission

Cited by 27 publications

References 28 publications

Cost and cost‐effectiveness of transitioning to universal initiation of lifelong antiretroviral therapy for allHIV‐positive pregnant and breastfeeding women in Swaziland

Cost and cost‐effectiveness of transitioning to universal initiation of lifelong antiretroviral therapy for allHIV‐positive pregnant and breastfeeding women in Swaziland

Cost‐per‐diagnosis as a metric for monitoring cost‐effectiveness of HIV testing programmes in low‐income settings in southern Africa: health economic and modelling analysis

Appraising the value of evidence generation activities: an HIV modelling study

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