Table 3.
Benefits, Costs, and Incremental Cost-Effectiveness of British Columbia Ministry of Health Seek and Treat for Optimal Prevention of Human Immunodeficiency Virus/AIDS Interventions
| Time Horizons Following the Intervention Period | ART Costs | Non-ART Costs | Human Immunodeficiency Virus Testing Costs | Interventiona Costs | Total Costs | QALYs | Incremental Cost- Effectiveness Ratiob |
|---|---|---|---|---|---|---|---|
| 5-year time horizon | $CDN (M) | $CDN (M) | $CDN (M) | $CDN (M) | $CDN (B) | (Millions) | |
| Status quo | $871.47 | $601.30 | $16.75 | -- | $67.15 | 24.96 | -- |
| Δ cost (M) | Δ cost (M) | Δ cost (M) | Δ cost (M) | Δ cost (M) | Δ QALYs | ||
| Hospital-based testing | 1.88 | –0.32 | 0.77 | 1.89 | 4.31 | 7.04 | $612051 |
| Outpatient clinic testing | 2.08 | –0.32 | 1.40 | 2.63 | 5.87 | 7.26 | $808749 |
| ED testing | 2.89 | –0.47 | 1.42 | 2.11 | 6.09 | 10.40 | $585985 |
| ART initiation | 6.82 | –1.69 | 0.00 | 4.28 | 9.67 | 94.91 | $101877 |
| ART retentionc | 5.90 | –0.47 | 0.00 | 14.75 | 20.34 | 43.16 | $471385 |
| Combined interventions, sustained | 19.55 | –3.27 | 3.58 | 25.67 | 46.26 | 164.12 | $281892 |
| Combined interventions, 2011–2013 onlyd | 10.67 | –2.19 | 0.83 | 15.18 | 25.02 | 122.30 | $204578 |
| 10-year time horizon | $CDN (M) | $CDN (M) | $CDN (M) | $CDN (M) | $CDN (B) | (Millions) | |
| Status quo | $1429.18 | $896.87 | $26.08 | -- | $104.45 | 38.81 | -- |
| Δ cost (M) | Δ cost (M) | Δ cost (M) | Δ cost (M) | Δ cost (M) | Δ QALYs | ||
| Hospital-based testing | 4.31 | –1.16 | 1.29 | 2.53 | 7.36 | 45.06 | $163396 |
| Outpatient clinic testing | 4.92 | –1.20 | 2.34 | 3.37 | 9.83 | 48.82 | $201410 |
| ED testing | 6.74 | –1.75 | 2.38 | 2.61 | 10.58 | 69.01 | $153352 |
| ART initiation | 9.52 | –2.60 | 0.00 | 5.90 | 13.50 | 204.29 | $66102 |
| ART retentionc | 9.52 | –0.92 | 0.00 | 20.35 | 29.38 | 92.42 | $317911 |
| Combined interventions, sustained | 34.50 | –7.47 | 5.99 | 34.77 | 70.23 | 457.78 | $153414 |
| Combined interventions, 2011–2013 onlyd | 12.67 | –3.48 | 0.83 | 15.18 | 26.45 | 253.30 | $104427 |
| 25-year time horizon | $CDN (M) | $CDN (M) | $CDN (M) | $CDN (M) | $CDN (B) | (Millions) | |
| Status quo | $2778.53 | $1510.33 | $48.22 | -- | $193.01 | 71.69 | -- |
| Δ cost (M) | Δ cost (M) | Δ cost (M) | Δ cost (M) | Δ cost (M) | Δ QALYs | ||
| Hospital-based testing | 6.26 | –4.83 | 2.53 | 3.98 | 10.22 | 295.88 | $34544 |
| Outpatient clinic testing | 7.75 | –5.28 | 4.59 | 5.04 | 14.54 | 333.29 | $43623 |
| ED testing | 9.79 | –7.76 | 4.67 | 3.73 | 14.03 | 464.44 | $30216 |
| ART initiation | 11.79 | –4.10 | 0.00 | 9.55 | 19.60 | 586.52 | $33423 |
| ART retentionc | 16.56 | –2.82 | 0.00 | 32.93 | 48.51 | 304.02 | $159551 |
| Combined interventions, sustained | 49.74 | –23.28 | 11.74 | 55.23 | 105.34 | 1906.30 | $55258 |
| Combined interventions, 2011–2013 onlyd | 9.76 | –6.20 | 0.83 | 15.18 | 23.17 | 637.42 | $36356 |
Abbreviations: ART, combination antiretroviral therapy; B, billions; CDN, Canadian dollars; ED, emergency department; M, millions; QALY, quality-adjusted life-year.
Δ incremental costs/QALYs.
Costs of public health intervention.
Incremental cost-effectiveness ratio (ICER) of the intervention vs the counterfactual status quo: ICER = (Costintervention – Costsstatus quo)/(QALYintervetnion – QALYstatus quo).
ART retention includes the initiatives targeting preventing ART dropouts and enhancing reengagement among treatment-discontinued people living with human immunodeficiency virus.
Reverting back to the counterfactual status quo-levels of human immunodeficiency virus testing and treatment engagement for the remainder of the study time horizon.