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Routine HIV screening in France: clinical impact and cost-effectiveness.

Publication ,  Journal Article
Yazdanpanah, Y; Sloan, CE; Charlois-Ou, C; Le Vu, S; Semaille, C; Costagliola, D; Pillonel, J; Poullié, A-I; Scemama, O; Deuffic-Burban, S ...
Published in: PLoS One
October 1, 2010

BACKGROUND: In France, roughly 40,000 HIV-infected persons are unaware of their HIV infection. Although previous studies have evaluated the cost-effectiveness of routine HIV screening in the United States, differences in both the epidemiology of infection and HIV testing behaviors warrant a setting-specific analysis for France. METHODS/PRINCIPAL FINDINGS: We estimated the life expectancy (LE), cost and cost-effectiveness of alternative HIV screening strategies in the French general population and high-risk sub-populations using a computer model of HIV detection and treatment, coupled with French national clinical and economic data. We compared risk-factor-based HIV testing ("current practice") to universal routine, voluntary HIV screening in adults aged 18-69. Screening frequencies ranged from once to annually. Input data included mean age (42 years), undiagnosed HIV prevalence (0.10%), annual HIV incidence (0.01%), test acceptance (79%), linkage to care (75%) and cost/test (€43). We performed sensitivity analyses on HIV prevalence and incidence, cost estimates, and the transmission benefits of ART. "Current practice" produced LEs of 242.82 quality-adjusted life months (QALM) among HIV-infected persons and 268.77 QALM in the general population. Adding a one-time HIV screen increased LE by 0.01 QALM in the general population and increased costs by €50/person, for a cost-effectiveness ratio (CER) of €57,400 per quality-adjusted life year (QALY). More frequent screening in the general population increased survival, costs and CERs. Among injection drug users (prevalence 6.17%; incidence 0.17%/year) and in French Guyana (prevalence 0.41%; incidence 0.35%/year), annual screening compared to every five years produced CERs of €51,200 and €46,500/QALY. CONCLUSIONS/SIGNIFICANCE: One-time routine HIV screening in France improves survival compared to "current practice" and compares favorably to other screening interventions recommended in Western Europe. In higher-risk groups, more frequent screening is economically justifiable.

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Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

October 1, 2010

Volume

5

Issue

10

Start / End Page

e13132

Location

United States

Related Subject Headings

  • Sensitivity and Specificity
  • Quality of Life
  • Prevalence
  • Middle Aged
  • Male
  • Incidence
  • Humans
  • HIV Infections
  • General Science & Technology
  • France
 

Citation

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Chicago
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Yazdanpanah, Y., Sloan, C. E., Charlois-Ou, C., Le Vu, S., Semaille, C., Costagliola, D., … Paltiel, A. D. (2010). Routine HIV screening in France: clinical impact and cost-effectiveness. PLoS One, 5(10), e13132. https://doi.org/10.1371/journal.pone.0013132
Yazdanpanah, Yazdan, Caroline E. Sloan, Cécile Charlois-Ou, Stéphane Le Vu, Caroline Semaille, Dominique Costagliola, Josiane Pillonel, et al. “Routine HIV screening in France: clinical impact and cost-effectiveness.PLoS One 5, no. 10 (October 1, 2010): e13132. https://doi.org/10.1371/journal.pone.0013132.
Yazdanpanah Y, Sloan CE, Charlois-Ou C, Le Vu S, Semaille C, Costagliola D, et al. Routine HIV screening in France: clinical impact and cost-effectiveness. PLoS One. 2010 Oct 1;5(10):e13132.
Yazdanpanah, Yazdan, et al. “Routine HIV screening in France: clinical impact and cost-effectiveness.PLoS One, vol. 5, no. 10, Oct. 2010, p. e13132. Pubmed, doi:10.1371/journal.pone.0013132.
Yazdanpanah Y, Sloan CE, Charlois-Ou C, Le Vu S, Semaille C, Costagliola D, Pillonel J, Poullié A-I, Scemama O, Deuffic-Burban S, Losina E, Walensky RP, Freedberg KA, Paltiel AD. Routine HIV screening in France: clinical impact and cost-effectiveness. PLoS One. 2010 Oct 1;5(10):e13132.

Published In

PLoS One

DOI

EISSN

1932-6203

Publication Date

October 1, 2010

Volume

5

Issue

10

Start / End Page

e13132

Location

United States

Related Subject Headings

  • Sensitivity and Specificity
  • Quality of Life
  • Prevalence
  • Middle Aged
  • Male
  • Incidence
  • Humans
  • HIV Infections
  • General Science & Technology
  • France