International Journal of Technology Assessment in Health Care

ASSESSMENTS

Economic evaluation, human immunodeficiency virus infection and screening: A review and critical appraisal of economic studies

Onome Dibosa-Osadolora1 and Tracy Robertsa2

a1 The Bridge Clinic

a2 University of Birmingham

Abstract

Objectives: The aim of this study was to review, systematically and critically, evidence used to derive estimates of cost-effectiveness of human immunodeficiency virus (HIV) screening.

Methods: A systematic review was conducted. Searched were three main electronic bibliographic databases from 1993 to 2008 using key words including HIV, mass screening, HAART, economic evaluation, cost-effectiveness analysis, modeling. We included studies of sexually transmitted HIV infection in both sexes, including studies comparing diagnostic testing protocols and partner notification. Outcomes included were cases of HIV infection detected, deterioration to the AIDS state, secondary transmission of HIV, the quality-adjusted life-years/survival, costs, and cost-effectiveness of HIV screening.

Results: Eighty-four papers were identified; ten of which were formal economic evaluations, one cost study, three effectiveness studies, and three systematic reviews of HIV prevention programs. The predominant assertion was that HIV screening is cost-effective; methodological problems, such as the preponderance of static models which are inappropriate for infectious diseases, varying perspectives from which the studies were analyzed, and arbitrary threshold incremental cost-effectiveness ratio levels, limited the validity of these findings, and their usefulness in informing health policy decisions.

Conclusions: The majority of published economic evaluations are based on inappropriate static models. This flaw renders the results of these studies as inconclusive and the purported cost-effectiveness of HIV screening debatable. The results of this review could form a basis for consideration of further research and analysis by health economists into the cost-effectiveness of HIV screening.

Footnotes

This study represents work carried out by Dr. Onome Dibosa-Osadolor in conjunction with Professor Tracy Roberts, for her MSc dissertation in Health Economics and Health Policy at the University of Birmingham. The dissertation was motivated by an earlier study by Tracy Roberts on the NCCHTA funded Chlamydia Screening Studies (ClaSS) project. The current work was carried out unfunded. Professor Tracy Roberts is funded by the Higher Education Funding Council for England (HEFCE) at the University of Birmingham. The authors thank Dr. John Saunders for his expert advice on the natural history of HIV.