Economic and health implications from earlier detection of HIV infection ă in the United Kingdom

Purpose: To model the budget and survival impact of implementing ă interventions to increase the proportion of HIV infections detected ă early in a given UK population. ă Patients and methods: A Microsoft Excel decision model was designed to ă generate a set of outcomes for a defined population. Survival was ă modeled on the Collaboration of Observational HIV Epidemiological ă Research Europe (COHERE) study extrapolated to a 5-year horizon as a ă constant hazard. Hazard rates were specific to age, sex, and whether ă detection was early or late. The primary outcomes for each year up to 5 ă years were: annual costs, numbers of infected cases, hospital ă admissions, and surviving cases. Three locations in the UK were chosen ă to model outcomes across a range of HIV prevalence areas: Lambeth, ă Southwark, and Lewisham (LSL), Greater Manchester Cluster (GMC), and ă Kent and Medway (K&M). ă Results: In LSL, the projected cumulative cost savings over 5 years were ă 3,210,206 pound or 5,290,206 pound when including the value of the 104 ă life-years saved. Savings were insensitive to transmission rates, but ă sensitive in direct proportion to the percentage shift from late to ă early detection. In GMC, savings were in a similar proportion to LSL, ă but the magnitude was smaller, as a consequence of the lower base-case ă HIV prevalence. In K&M, with a smaller population and lower HIV ă prevalence than GMC, savings were commensurately smaller (733,202 pound ă cumulatively over 5 years). ă Conclusion: The results strengthen the rationale for implementing ă increased testing in high prevalence areas. However, in areas of low ă prevalence, it is unlikely that costs will be returned over a 5-year ă period.