Cost-effectiveness of frequent HIV screening among men who have sex with men in China.

BACKGROUND

China continues to have a substantial burden of HIV/AIDS, with men who have sex with men (MSM) being the fastest-growing population at risk. To identify priority HIV screening strategies, there is an urgent need for more economic evidence to assess the balance between costs and benefits of intensify testing, particularly for MSM at high risk of HIV acquisition. This study aimed to assess the immediate impact of more frequent HIV testing among MSM in China from a cost-effective perspective.

METHODS

A model of HIV detection and transmission was used to evaluate the costs and effectiveness of more frequent screening, based on varying testing intervals and technologies. The model was applied to separate hypothetical cohorts of 100,000 MSM, categorized as low- and high-risk of HIV acquisition. Overall program costs were calculated using routine testing algorithms from relevant studies in China. Epidemiological, behavioral and health-state utility parameters were derived from published data, with HIV continuum-of-care indicators obtained from assumptions when required. Transmission averted, quality-adjusted life years (QALYs) gained and incremental cost-effectiveness ratios (ICERs) were estimated, along with sensitivity analyses to explore model uncertainty.

RESULTS

For the cohort of high-risk MSM, quarterly or semiannual testing was found to be cost-saving or cost-effective when compared to annual testing. However, for the cohort of low-risk MSM, testing every 3 months was not cost-effective compared with annual testing, with ICERs exceeding three times the GDP per capita ($37,663). Compared to annual testing, semiannual testing proved cost-effective for low-risk MSM, with ICERs of $34,060 or $36,938 for the 4th-generation rapid or laboratory tests, respectively. In sensitivity analyses, the results remained robust and were sensitive to HIV transmission and incidence rates. Threshold analyses of total program costs indicated that increasing testing frequency for high-risk MSM might incur additional implementation costs but could still be cost-effective.

CONCLUSION

For high-risk MSM, both 3-monthly and 6-monthly HIV screening are cost-effective compared to less frequent screening, even when accounting for increased investment in testing recruitment and implementation. For low-risk MSM in China, more frequent screening strategies are generally not preferred over annual HIV screening.