Cost-effectiveness of a fourth-generation combination immunoassay for human immunodeficiency virus (HIV) antibody and p24 antigen for the detection of HIV infections in the United States

Lael Cragin, Feng Pan, Siyang Peng, Jonathan Zenilman, Julia Green, Cynthia Doucet, Donald Chalfin, Greg De Lissovoy

Research output: Contribution to journalArticle

Abstract

Purpose: The US Food and Drug Administration recently approved the first 4th-generation HIV test. This study evaluated the cost-effectiveness of the 4th-generation assay versus a 3rd-generation test in screening for HIV infections in the United States. Methods: An exploratory microsimulation model was developed that follows hypothetical individuals and simulates the course of HIV/AIDS, treatment with highly active antiretroviral therapy, and transmissions. Results: With a 1% HIV prevalence, screening 1.5 million individuals with the 4th-versus 3rd-generation assay resulted in detection of 266 additional HIV cases at an incremental cost per additional HIV case detected of $63,763, an additional 489 life years and 395 quality-adjusted life years (QALYs), and 26 HIV transmissions prevented. Although lifetime costs were increased by $33.6 million, the incremental cost/QALY gained was $85,206. The 4th-generation test was more cost-effective in high incidence settings. The number needed to screen to detect one additional HIV case was 5,635. Conclusions: Screening using the 4th-generation assay may be cost-effective for HIV detection in appropriate settings, resulting in increased case identification, fewer transmissions, extended life, and increased quality of life. With early and accurate detection, this 4th-generation test may provide a suitable alternative to current 3rd-generation tests.

Original languageEnglish (US)
Pages (from-to)11-22
Number of pages12
JournalHIV Clinical Trials
Volume13
Issue number1
DOIs
StatePublished - Jan 1 2012

Keywords

  • HIV infection
  • cost-effectiveness
  • screening
  • testing

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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