Angela Hutchinson and colleagues conducted a cost-effectiveness analysis of pooled nucleic acid amplification testing following HIV testing and show that it is not cost-effective at recommended antibody testing intervals for high-risk persons except in very high-incidence settings

AB Hutchinson

AC Weintrob

AD Paltiel

Angela B. Hutchinson

AS Fauci

B Louie

Bernard M. Branson

Berry Bennett

BM Branson

BM Yeh JM

BR Jackson

BR Schackman

C Fagard

CD Pilcher

DA Marshall

DJ Helms

DJ Westreich

FH Priddy

G Marks

GD Sanders

GS Zaric

HC Kung

HI Hall

HM Truong

J Stekler

JA Kelly

James D. Heffelfinger

JD Stekler

LB Hightow-Weidman

MR Gold

NM Zetola

P Patel

PA Ubel

Paul G. Farnham

Peter R. Kerndt

PG Farnham

PM Sullivan TJ

Pragna Patel

Robert K. Bolan

RS Braithwaite

Seth C. Kalichman

SL Stramer

SM Owen

Stephanie L. Sansom

T Schacker

TC Quinn

Timothy J. Sullivan

TO Tengs

Vimalanand S. Prabhu

VS Prabhu

WC Miller

WR Golden MR

English

PubMed

BACKGROUND: Detection of acute HIV infection (AHI) with pooled nucleic acid amplification testing (NAAT) following HIV testing is feasible. However, cost-effectiveness analyses to guide policy around AHI screening are lacking; particularly after more sensitive third-generation antibody screening and rapid testing. METHODS AND FINDINGS: We conducted a cost-effectiveness analysis of pooled NAAT screening that assessed the prevention benefits of identification and notification of persons with AHI and cases averted compared with repeat antibody testing at different intervals. Effectiveness data were derived from a Centers for Disease Control and Prevention AHI study conducted in three settings: municipal sexually transmitted disease (STD) clinics, a community clinic serving a population of men who have sex with men, and HIV counseling and testing sites. Our analysis included a micro-costing study of NAAT and a mathematical model of HIV transmission. Cost-effectiveness ratios are reported as costs per quality-adjusted life year (QALY) gained in US dollars from the societal perspective. Sensitivity analyses were conducted on key variables, including AHI positivity rates, antibody testing frequency, symptomatic detection of AHI, and costs. Pooled NAAT for AHI screening following annual antibody testing had cost-effectiveness ratios exceeding US$200,000 per QALY gained for the municipal STD clinics and HIV counseling and testing sites and was cost saving for the community clinic. Cost-effectiveness ratios increased substantially if the antibody testing interval decreased to every 6 months and decreased to cost-saving if the testing interval increased to every 5 years. NAAT was cost saving in the community clinic in all situations. Results were particularly sensitive to AHI screening yield. CONCLUSIONS: Pooled NAAT screening for AHI following negative third-generation antibody or rapid tests is not cost-effective at recommended antibody testing intervals for high-risk persons except in very high-incidence settings

Angela B Hutchinson

Stephanie L Sansom

Paul G Farnham

Timothy J Sullivan

Peter R Kerndt

Robert K Bolan

James D Heffelfinger

Vimalanand S Prabhu

Bernard M Branson

Directory of Open Access Journals

PLoS Medicine

Cost-effectiveness of pooled nucleic acid amplification testing for acute HIV infection after third-generation HIV antibody screening and rapid testing in the United States: a comparison of three public health settings.

Detection of acute HIV infection (AHI) with pooled nucleic acid amplification testing (NAAT) following HIV testing is feasible. However, cost-effectiveness analyses to guide policy around AHI screening are lacking; particularly after more sensitive third-generation antibody screening and rapid testing.We conducted a cost-effectiveness analysis of pooled NAAT screening that assessed the prevention benefits of identification and notification of persons with AHI and cases averted compared with repeat antibody testing at different intervals. Effectiveness data were derived from a Centers for Disease Control and Prevention AHI study conducted in three settings: municipal sexually transmitted disease (STD) clinics, a community clinic serving a population of men who have sex with men, and HIV counseling and testing sites. Our analysis included a micro-costing study of NAAT and a mathematical model of HIV transmission. Cost-effectiveness ratios are reported as costs per quality-adjusted life year (QALY) gained in US dollars from the societal perspective. Sensitivity analyses were conducted on key variables, including AHI positivity rates, antibody testing frequency, symptomatic detection of AHI, and costs. Pooled NAAT for AHI screening following annual antibody testing had cost-effectiveness ratios exceeding US$200,000 per QALY gained for the municipal STD clinics and HIV counseling and testing sites and was cost saving for the community clinic. Cost-effectiveness ratios increased substantially if the antibody testing interval decreased to every 6 months and decreased to cost-saving if the testing interval increased to every 5 years. NAAT was cost saving in the community clinic in all situations. Results were particularly sensitive to AHI screening yield.Pooled NAAT screening for AHI following negative third-generation antibody or rapid tests is not cost-effective at recommended antibody testing intervals for high-risk persons except in very high-incidence settings.Please see later in the article for the Editors' Summar

Hutchinson Angela B.

Patel Pragna

Sansom Stephanie L.

Farnham Paul G.

Sullivan Timothy J.

Bennett Berry

Kerndt Peter R.

Bolan Robert K.

Heffelfinger James D.

Prabhu Vimalanand S.

Branson Bernard M.

Public Library of Science (PLOS)

Cost-Effectiveness of Pooled Nucleic Acid Amplification Testing for Acute HIV Infection after Third-Generation HIV Antibody Screening and Rapid Testing in the United States: A Comparison of Three Public Health Settings

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Found at: doi:10.1371/journal.pmed.1000342.s001 (0.16 MB DOC) Author Contributions ICMJE criteria for authorship read and met: ABH PP SLS PGF TJS BB PRK RKB JDH VSP BMB. Agree with the manuscript’s results and conclusions:

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Prevention CfDCa

Rapid Test 3 rd-Gen EIA Rapid Test 3 rd-Gen EIA Rapid Test Base case: HIV diagnosis 1 y after infection w/o NAAT HIV infections averted 0.41 0.51 0.90 1.46 0.32 0.42 HIV treatment costs averted

Rapid Test 3 rd-Gen EIA Rapid Test 3 rd-Gen EIA Rapid Test Total program costs,

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Cost-Effectiveness of Pooled Nucleic Acid Amplification Testing for Acute HIV Infection after Third-Generation HIV Antibody Screening and Rapid Testing in the United States: A Comparison of Three Public Health Settings

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