Table 2.
Cost-effectiveness Results Over 20 Years in Each Country
| Strategiesb | Undiscounted | 3% Discounted | ICERc ($/YLS) | ||||
|---|---|---|---|---|---|---|---|
| Total Costs (% Increase), $ | YLS (‰ Increase) | Total Costs, $ |
YLS | ||||
| Belarus (GDP per capita = $7575) | |||||||
| 5) ART, DIAG HIV (90% vs 66%) | 331820 k | (-5.0) | 12650 | (+0.1) | 249570 k | 7890 | Cost-savingd |
| 4) ART (90% vs 67%) | 340050 k | (-2.6) | 4440 | (+0.0) | 253730 k | 2770 | Cost-saving |
| 1) Baseline | 349220 k | (ref) | -- | (ref) | 259700 k | -- | -- |
| 0) Alternative scenario with 2005 coverages | 368880 k | (+5.6) | -21080 | (-0.2) | 269600 k | -13220 | Dominatede |
| 8) NSP, OST, ART, DIAG HIV | 371300 k | (+6.3) | 53560 | (+0.4) | 279810 k | 34900 | 210 |
| 7) NSP, OST, ART | 379000 k | (+8.5) | 45710 | (+0.3) | 283670 k | 30000 | Dominated |
| 3) NSP, OST (20% vs 1.2%) | 387500 k | (+11.0) | 41500 | (+0.3) | 289210 k | 27370 | Dominated |
| 2) NSP (40% vs 8% at baseline) | 390560 k | (+11.8) | 1600 | (+0.0) | 291220 k | 980 | Dominated |
| 6) ART, DIAG HIV, anti-HCV (50% vs 0.001%) | 383640 k | (+9.9) | 17350 | (+0.1) | 293640 k | 10910 | Dominated |
| 9) NSP, OST, ART, DIAG HIV, anti-HCV | 416790 k | (+19.3) | 58250 | (+0.4) | 319580 k | 37920 | Ext. dominf |
| 10) ART, DIAG HIV, anti-HCV, DIAG HCV (75% vs 27%) | 444900 k | (+27.4) | 23100 | (+0.2) | 348050 k | 14620 | Dominated |
| 11) NSP, OST, ART, DIAG HIV, anti-HCV, DIAG HCV | 466850 k | (+33.7) | 63830 | (+0.5) | 365790 k | 41540 | 12960 |
| Georgia (GDP per capita = $3602) | |||||||
| 5) ART (90% vs 88%), DIAG HIVa | 468600 k | (-0.1) | 160 | (+0.0) | 350180 k | 100 | Cost-saving |
| 1) Baseline | 469080 k | (ref) | -- | (ref) | 350490 k | -- | -- |
| 0) Alternative scenario with 2005 coverages | 484390 k | (+3.2) | -15730 | (-0.3) | 359000 k | -10080 | Dominated |
| 8) NSP, OST, ART, DIAG HIVa | 482520 k | (+2.8) | 17530 | (+0.3) | 361110 k | 11620 | 910 |
| 3) NSP, OST (20% vs 5%) | 482940 k | (+2.9) | 17390 | (+0.3) | 361380 k | 11530 | Dominated |
| 2) NSP (40% vs 6% at baseline) | 483920 k | (+3.1) | 630 | (+0.0) | 362020 k | 380 | Dominated |
| 6) ART, anti-HCV (50% vs 0.001%) | 553000 k | (+15.2) | 4020 | (+0.1) | 421710 k | 2580 | Dominated |
| 9) NSP, OST, ART, DIAG HIV,a anti-HCV | 557650 k | (+15.9) | 21400 | (+0.3) | 426360 k | 14100 | 26230 |
| 11) NSP, OST, ART, DIAG HIV,a anti-HCV, DIAG HCV | 647810 k | (+27.6) | 26000 | (+0.4) | 507910 k | 17080 | 27460 |
| 10) ART, DIAG HIV,a anti-HCV, DIAG HCV (75% vs 27%) | 663000 k | (+29.2) | 8740 | (+0.1) | 517430 k | 5620 | Dominated |
| Kazakhstan (GDP per capita = $13 172) | |||||||
| 8) NSP, OST, ART, DIAG HIVa | 1661940 k | (-6.9) | 185280 | (+0.8) | 1237040 k | 118680 | Cost-saving |
| 3) NSP, OST (20% vs 0.2%) | 1710180 k | (-3.9) | 160720 | (+0.7) | 1265370 k | 103610 | Cost-saving |
| 5) ART (90% vs 38%), DIAG HIVa | 1713180 k | (-3.7) | 32750 | (+0.1) | 1267570 k | 19940 | Cost-saving |
| 0) Alternative scenario with 2005 coverages | 1784870 k | (+0.4) | -31500 | (-0.1) | 1301450 k | -19320 | Cost-saving |
| 1) Baseline | 1777110 k | (ref) | -- | (ref) | 1304890 k | -- | -- |
| 2) NSP (60% vs 37% at baseline) | 1776030 k | (-0.1) | 7840 | (+0.0) | 1307680 k | 4720 | Ext. domin |
| 9) NSP, OST, ART, DIAG HIV,a anti-HCV | 1775600 k | (-0.1) | 196170 | (+0.9) | 1338410 k | 125680 | 270 |
| 6) ART, anti-HCV (50% vs 0.001%) | 1888810 k | (+5.9) | 43910 | (+0.2) | 1411650 k | 27110 | Dominated |
| 11) NSP, OST, ART, DIAG HIV,a anti-HCV, DIAG HCV | 2002450 k | (+11.3) | 210090 | (+0.9) | 1534280 k | 134640 | 21850 |
| 10) ART, DIAG HIV,a anti-HCV, DIAG HCV (75% vs 27%) | 2258080 k | (+21.3) | 58580 | (+0.3) | 1706340 k | 36520 | Dominated |
| Republic of Moldova (GDP per capita = $2230) | |||||||
| 5) ART, DIAG HIV (90% vs 66%) | 349310 k | (-8.0) | 7670 | (+0.1) | 256900 k | 4730 | Cost-saving |
| 8) NSP, OST, ART, DIAG HIV | 353240 k | (-6.8) | 21050 | (+0.4) | 260180 k | 13510 | Cost-saving |
| 4) ART (90% vs 46%) | 359910 k | (-4.8) | 4240 | (+0.1) | 263000 k | 2620 | Cost-saving |
| 7) NSP, OST, ART | 363160 k | (-3.9) | 17800 | (+0.3) | 265870 k | 11500 | Cost-saving |
| 6) ART, DIAG HIV, anti-HCV (50% vs 0.001%) | 367310 k | (-2.7) | 9050 | (+0.2) | 272220 k | 5630 | Cost-saving |
| 1) Baseline | 377210 k | (ref) | -- | (ref) | 273800 k | -- | -- |
| 9) NSP, OST, ART, DIAG HIV, anti-HCV | 369030 k | (-2.2) | 22430 | (+0.4) | 274000 k | 14400 | 10 |
| 3) NSP, OST (20% vs 1.6%) | 379220 k | (+0.5) | 13910 | (+0.3) | 275970 k | 9090 | Dominated |
| 2) NSP (40% vs 34% at baseline) | 382290 k | (+1.3) | 580 | (+0.0) | 277850 k | 350 | Dominated |
| 0) Alternative scenario with 2005 coverages | 398860 k | (+5.4) | -6220 | (-0.1) | 286920 k | -3860 | Dominated |
| 11) NSP, OST, ART, DIAG HIV, anti-HCV, DIAG HCV | 388590 k | (+2.9) | 24080 | (+0.5) | 291740 k | 15470 | 16600 |
| 10) ART, DIAG HIV, anti-HCV, DIAG HCV (75% vs 27%) | 390700 k | (+3.5) | 10740 | (+0.2) | 292760 k | 6720 | Dominated |
| Tajikistan (GDP per capita = $1037) | |||||||
| 0) Alternative scenario with 2005 coverages | 137130 k | (-16.1) | -12540 | (-0.1) | 96770 k | -7760 | Cost-saving |
| 4) ART (90% vs 69%) | 158660 k | (-0.4) | 2100 | (+0.0) | 113370 k | 1290 | Cost-saving |
| 5) ART, DIAG HIV (90% vs 63%) | 158700 k | (-0.3) | 6050 | (+0.1) | 113610 k | 3710 | Cost-saving |
| 1) Baseline | 159250 k | (ref) | -- | (ref) | 113680 k | -- | -- |
| 6) ART, DIAG HIV, anti-HCV (50% vs 0.001%) | 163790 k | (+2.8) | 7040 | (+0.1) | 117290 k | 4340 | Ext. domin |
| 7) NSP, OST, ART | 168020 k | (+5.2) | 26630 | (+0.3) | 120460 k | 17180 | Ext. domin |
| 8) NSP, OST, ART, DIAG HIV | 168110 k | (+5.3) | 30200 | (+0.3) | 120720 k | 19380 | 360 |
| 3) NSP, OST (20% vs 1.2%) | 168560 k | (+5.5) | 24900 | (+0.3) | 120760 k | 16120 | Dominated |
| 2) NSP (40% vs 25% at baseline) | 170490 k | (+6.6) | 1260 | (+0.0) | 122010 k | 760 | Dominated |
| 9) NSP, OST, ART, HIV DIAG, NEW DAA | 171660 k | (+7.2) | 31130 | (+0.3) | 123400 k | 19970 | 4550 |
| 10) ART, DIAG HIV, anti-HCV, DIAG HCV (75% vs 27%) | 175960 k | (+9.5) | 9220 | (+0.1) | 126300 k | 5710 | Dominated |
| 11) NSP, OST, ART, DIAG HIV, anti-HCV, DIAG HCV | 179090 k | (+11.1) | 33080 | (+0.3) | 129220 k | 21210 | 4690 |
Abbreviations: ART, antiretroviral therapy; DIAG, diagnosis; GDP, gross domestic product; NEW DAA, new direct active agent; NSP, needle-syringe program; OST, opioid substitution therapy; YLS, years of life saved.
aIn Georgia and Kazakhstan, HIV screening currently being ≥90% among PWID, the increase of the coverage was not included in these strategies.
bBaseline: current coverages, NSP, OST, ART, DIAG, NEW DAA, YLS, GDP.
cIncremental cost-effectiveness ratios in US dollar per years of life saved ($/YLS). Calculated from the 3% discounted outcomes; the comparator strategy is always the next smallest, not dominated, alternative.
dCost-saving: less expensive and more effective than the current strategy (baseline).
eDominated: less effective and more costly than some alternative strategies.
fExtendedly dominated: has an incremental cost-effectiveness ratio that is greater than that of a more effective strategy.