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AIDS and Behavior

, Volume 22, Issue 11, pp 3726–3733 | Cite as

The Cost and Cost-utility of Three Public Health HIV Case-finding Strategies: Evidence from Rhode Island, 2012–2014

  • Xinqi C. Li
  • Lillian Kusi
  • Theodore Marak
  • Thomas Bertrand
  • Philip A. Chan
  • Omar GalárragaEmail author
Original Paper

Abstract

To evaluate three testing strategies to identify new HIV diagnoses in Rhode Island (RI). RI deployed three testing strategies, by using rapid HIV tests at clinical settings, community-based organization (CBO) settings, and the Partner Notification Services (PNS) program from 2012 to 2014. We reviewed the rapid HIV test results and confirmatory test results to identify new diagnoses, and conducted a cost-utility analysis. The average cost per new diagnosis was $33,015 at CBO settings, $5446 at clinical settings, and $33,818 at the PNS program. The cost-utility analysis showed the state-wide program was cost-saving; testing was cost-saving at clinical settings, and cost-effective at CBO settings and the PNS program. Further analyses showed that cost-effectiveness varied widely across CBOs. The HIV testing expansion program in RI was cost-saving overall. The heterogeneity of cost-effectiveness across settings should provide guidance to officials for allocation of future resources to HIV testing.

Keywords

HIV testing Rapid HIV tests Cost utility Economic evaluation 

Resumen

Evaluar la costo-efectividad de tres estrategias de pruebas de detección del VIH para identificar nuevos diagnósticos en Rhode Island (RI). Del 2012 al 2014, RI implementó tres estrategias de pruebas de detección del VIH, mediante el uso de pruebas rápidas: en espacios clínicos, a través de organizaciones con base comunitaria (CBO, por sus siglas en inglés) y el programa de notificación de parejas sexuales (PNS). Se realizó una revisión detallada de los costos y resultados de las pruebas rápidas del diagnóstico del VIH y las pruebas confirmatorias para identificar los nuevos diagnósticos, y se llevó a cabo un análisis de costo-utilidad. El costo promedio por nuevo diagnóstico fue de $33,015 en la configuración de CBO, $5446 en la configuración clínica y $33,818 en el programa PNS. El análisis de costo-utilidad mostró que el programa a nivel estatal era costo-ahorrador; las pruebas de detección del VIH eran costo-ahorradoras en los entornos clínicos, y costo-efectivas en la configuración de CBO y el programa PNS. Otros análisis mostraron que la costo-efectividad variaba ampliamente entre las organizaciones comunitarias. El programa de expansión de las pruebas de detección del VIH en RI resulta en un ahorro de costos en general. La heterogeneidad de la eficacia en función de los costos en cada contexto debe ayudar a orientar la asignación de recursos futuros para las pruebas de detección del VIH.

Palabras claves

Pruebas de detección del VIH Pruebas rápidas del VIH Costo-utilidad Costo-efectividad Evaluación económica Rhode Island 

Notes

Funding

This study was funded by the Rhode Island Department of Health through a Preventive Health and Health Services (PHHS) Block Grant from the Centers for Disease Control and Prevention (CDC).

Compliance with Ethical Standards

Conflict of interest

All coauthors declare no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Xinqi C. Li
    • 1
  • Lillian Kusi
    • 2
  • Theodore Marak
    • 2
  • Thomas Bertrand
    • 2
  • Philip A. Chan
    • 2
  • Omar Galárraga
    • 1
    Email author
  1. 1.Department of Health Services Research, Policy, and PracticeBrown University School of Public HealthProvidenceUSA
  2. 2.Center for HIV/AIDS, STDs, Viral Hepatitis, and TBRhode Island Department of HealthProvidenceUSA

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