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Cost-effectiveness of point-of-care testing for early infant HIV diagnosis in Zimbabwe

July 08, 2019

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The authors were interested in whether new point-of-care (POC) tests for early infant HIV diagnosis could increase access to testing, shorten time to results and lead to earlier initiation of antiretroviral therapy in Zimbabwe. They used a model to analyse the clinical benefits, costs and cost-effectiveness of replacing conventional assays for early infant HIV diagnosis with POC assays at age 6 weeks in Zimbabwe. The model outcomes included survival, life expectancy and mean lifetime per-person treatment cost. Incremental cost-effectiveness ratios (ICERs) of ≤$1010 (Zimbabwe’s annual GDP) per year of life saved were considered to be cost-effective. The authors found that when conventional assays were used for early infant diagnosis, the projected undiscounted life expectancy was 22·7 years for infants with HIV and 62·5 years for all HIV-exposed infants, at a cost of $610 per HIV-exposed infant. Use of POC assays instead improved life expectancy to 25·5 years among infants with HIV and 62·6 years among HIV-exposed infants at a cost of $690 per HIV-exposed infant. At age 12 weeks, survival among all infants with HIV was 76·1% with conventional assays and 83·5% with POC testing. The ICER of POC vs. conventional assays for early infant diagnosis was $680 per year of life saved. POC testing remained cost-effective as long as the specificity and sensitivity were greater than 92% and 65%, respectively. Therefore the use of POC assays for early infant HIV diagnosis in Zimbabwe will improve survival, extend life expectancy and be cost-effective for HIV-exposed infants.

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Frank SC, Cohn J, Dunning L, Sacks E, Walensky RP, et al. ISSN: Lancet HIV; 6(3): e182-e190

2019

Added: July 08, 2019