The authors were interested in the cost-effectiveness of a set of HIV testing and treatment engagement interventions (seek, test, treat and retain) initiated in British Columbia, Canada in 2011-2013. They used a previously-validated dynamic compartmental HIV transmission model to link individual-level health administrative data for HIV-infected patients and aggregate-level HIV testing data to estimate the cost-effectiveness of primary care testing (hospital, emergency department, outpatient), ART initiation and ART retention initiatives, versus a counterfactual scenario similar to the status quo. The authors found that emergency department testing was the best value at $30,216 per QALY gained and had the greatest impact on incidence and mortality among HIV-infected patients, while ART initiation provided the greatest QALY gains. The ART retention initiative was not found to be cost-effective. If these interventions were delivered in combination at the observed scale and sustained throughout the study period, a 12.8% reduction in cumulative HIV incidence and a 4.7% reduction in deaths among HIV-infected patients at an incremental cost of $55,258 per QALY gained will be achieved. These results were found to be most sensitive to the uncertainty in the number of undiagnosed patients with HIV. Therefore HIV testing and ART initiation interventions are cost-effective, while the ART retention intervention is not.
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