Table 2:
Health impact and cost-effectiveness of point-of care testing intervention across varying assumptions§
| Baseline | Lower background viral suppression on ART | 2X higher ART dropout | Lower bound intervention effectiveness | Upper bound intervention effectiveness | No reduction in HIV transmission among those on ART w/ VL>1000 | 2X higher reduction in HIV transmission among those on ART w/ VL>1000 | |
|---|---|---|---|---|---|---|---|
| Health Impact (%) | |||||||
| HIV infections averted | 4.5 (1.6, 7.6) | 4.0 (0.8, 7.1) | 3.8 (1.1, 6.4) | 2.2 (0.5, 5.2) | 6.9 (3.2, 10.2) | 5.6 (2.6, 8.6) | 2.6 (−1.0, 6.9) |
| HIV deaths averted | 3.9 (2.0, 6.0) | 3.8 (1.7, 5.9) | 3.6 (1.7, 5.3) | 2.2 (0.1, 4.1) | 6.6 (4.4, 8.6) | 4.2 (2.3, 6.0) | 3.6 (1.2, 5.6) |
| Cost-effectiveness ($ per DALY averted) by monthly clinic volume (number of ART initiations/month) | |||||||
| Clinic volume: 50 | −239 (−602, −96) | −229 (−721, −100) | −107 (−245, −36) | −209 (−582, −103) | −358 (−464, −103) | −161 (−281, −98) | −126 (−410, −18) |
| % under $500 threshold | 100% | 100% | 100% | 100% | 100% | 100% | 100% |
| Clinic volume: 40 | −72 (−176, 26) | −50 (−142, 144) | 40 (−68, 279) | −45 (−145, 63) | −82 (−125, −79) | −75 (−122, −18) | −39 (−175, 140) |
| % under $500 threshold | 100% | 99% | 97% | 98% | 100% | 100% | 98% |
| Clinic volume: 30 | 197 (−27, 863) | 242 (−39, 1,051) | 280 (−2, 1079) | 319 (−14, 908) | 49 (−41, 276) | 63 (−36, 328) | 374 (−17, 1,373) |
| % under $500 threshold | 93% | 87% | 91% | 85% | 97% | 97% | 87% |
| Clinic volume: 20 | 734 (93, 2,569) | 824 (69, 3,190) | 757 (107, 2,546) | 1045 (111, 2,960) | 305 (58, 890) | 339 (63, 1,075) | 1,197 (117, 4,567) |
| % under $500 threshold | 72% | 66% | 68% | 49% | 88% | 85% | 58% |
| Clinic volume: 10 | 2,348 (436, 7,681) | 2,571 (380, 9,720) | 2,190 (421, 6,779) | 3,226 (494, 9,159) | 1,073 (344, 2,738) | 1,169 (341, 3,213) | 2,451 (503, 8,474) |
| % under $500 threshold | 9% | 13% | 10% | 5% | 28% | 22% | 5% |
Values in parenthesis represent 90% model variability across 250 simulations. Values in green represent scenarios where the mean ICER is considered cost-effective at both thresholds of $500 and $1,175 per DALY averted. Values in yellow represent scenarios where the mean ICER is considered cost-effective using only the threshold of $1,175 per DALY averted and values in red exceed both thresholds. VL: Viral load
Lower background viral suppression on ART: 71%; 2X higher ART dropout: 10% annual dropout; Lower bound intervention effectiveness: 5% increase in viral suppression compared to SOC; Upper bound intervention effectiveness: 15% increase in viral suppression compared to SOC; No reduction in HIV transmission among those on ART w/ VL>1000: Individuals on ART with VL>1000 have same HIV transmissibility as those not on ART; 2X higher reduction in HIV transmission among those on ART w/ VL>1000: Individuals on ART with VL>1000 have 70% reduction in HIV transmissibility compared to those not on ART