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Impact of One-Time or Annual HIV Screening on Life Expectancy in France
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49th ICAAC (Interscience Conference on Antimicrobial Agents and Chemotherapy), September 12-15, 2009, San Francisco
Mark Mascolini
Annual HIV screening would add an estimated half-year to the lives of infected French residents from French Guyana, while adding almost a year to the lives of infected French injecting drug users (IDUs) [1]. This modeling study found that one-time voluntary HIV screening would improve quality-adjusted life years (QALYs) by a substantially lower factor than annual screening but would meet World Health Organization (WHO) standards for cost-effectiveness in France.
More than 40,000 HIV-infected people in France remain unaware of their infection. To estimate discounted life expectancy, cost, and cost-effectiveness of routine voluntary testing strategies, French and US investigators devised a computer model of HIV detection and treatment linked to French national clinical and economic data. They calculated the impact of three screening strategies--once, every 5 years, and annually--for 18- to 69-year-olds.
The model factored in an HIV test cost of 43 Euros (about $62), a testing acceptance rate of 79%, and a linkage to care rate of 75%. The investigators assumed that wider antiretroviral therapy moderately lowers the HIV transmission rate. The model also accounted for incidence of opportunistic diseases, HIV treatment, death rates, and associated costs and quality-of-life effects.
Time from HIV infection to diagnosis in France today averages 24 months. That span would drop to 22 months with one voluntary lifetime screening, to 18 months with screening every 5 years, and to 9 months with annual screening. The current average CD4 count at diagnosis, 370, would climb to 379 with one lifetime screening, to 400 with screening every 5 years, and to 444 with annual screening. One-time screening would lower the number of HIV transmissions from an infected person every 10 years by 7.7, while screening every 5 years would lower that number by 10.5 transmissions every 10 years and annual screening by 17.9 every 10 years. The cost-effectiveness of annual screening matches estimates for other common screening tests in France.
Current HIV screening strategies yield a discounted life expectancy of 242.81 quality-adjusted life months (QALMs) per person after HIV diagnosis. Adding a single lifetime HIV test would boost life expectancy to 244.12 QALMs, screening every 5 years would add 245.13 QALMs, and annual screening would add 246.35 QALMs.
Among gay men, whose HIV incidence stands at 0.99 per person-year, annual screening would translate into a survival benefit of only 0.05 QALYs (2.6 weeks) per HIV-positive person. Annual screening would have the greatest life-expectancy impact on French IDUs, who have an HIV incidence of 0.17 per person-year. For them, annual screening would extend life expectancy by an estimated 0.82 QALYs (42.6 weeks) per HIV-infected person. For natives of French Guyana, whose HIV incidence lies at 0.30 per person-year, annual screening would add 0.44 QALYs (22.9 weeks) per HIV-infected person.
Reference
1. Yazdanpanah Y, Sloan C, Charlois-Ou C, et al. Routine HIV screening in France: clinical impact and cost-effectiveness. 49th ICAAC (Interscience Conference on Antimicrobial Agents and Chemotherapy). September 12-15, 2009. San Francisco. Abstract H-241.
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