Cost-effectiveness Analysis Of An Expanded HIV Testing Strategy In Guangzhou

Objective:To assessed the costs and effectiveness of the HIV testing strategy in Guangzhou between2006and2011and to provide advice to the local policy makers in areas of China where HIV prevalence is among the top five, but with economic situations ranked among the best in China.Methods:Standard methods of cost-effectiveness analysis were used to evaluate the expanded HIV testing strategy in Guangzhou from2006to2011. The cost data of the expanded HIV testing strategy in Guangzhou were collected from local governmental agencies and are stated in Chinese Yuan. We obtained the total costs by splitting the cost sources into five categories, including financial input, manpower costs, fixed assets investment, HIV test reagent costs, etc. We collected cost data from130institutions that provide the HIV preliminary screening and one institution that provides HIV confirmatory testing. We used self-administered questionnaires and face-to-face interviews with HIV testing staff members at each institution to obtain cost-related information about manpower hours, salaries, equipment, and facilities of HIV testing laboratories. All the cost data obtained were actual expenses per year. The criteria to measure the effectiveness of the HIV testing strategy in Guangzhou included the number of people tested, the number found to be positive for HIV, and the number notified of their HIV diagnosis. All the data were obtained from the Guangzhou CDC on an annual basis. A Markov model was constructed to estimate the quality adjusted life years (QALYs) saved due to the expanded HIV testing in health care settings in Guangzhou.Results:The investment in the expanded HIV testing strategy in Guangzhou increased from2006to2011. Combining5subcategories of HIV testing costs, the overall annual cost of the HIV testing strategy in Guangzhou in2006was16.70 million Yuan, and in2011was38.45million Yuan. A large proportion of annual HIV testing costs were fixed assets costs, ranging from32%to56%. The number of people who received HIV testing increased in Guangzhou, from478,860in2006to1,790,810in2011, and9209HIV positive patients were found due to this strategy.The average cost-effectiveness ratio was13,800Yuan per person with HIV positive results and the average cost-effectiveness ratio was16,120Yuan per person notified of his/her HIV diagnosis. From2006to2011, the annual cost per person notified of his/her HIV diagnosis differed, ranging from10,260to25,170Yuan. With the increase of HIV seropositivity, the cost per person notified of HIV positivity decreased, which means that the cost per person notified of a new HIV diagnoses increased with declining HIV seropositivity rates. The average costs per averted HIV positive patient was0.12million Yuan, and according to the Markov model result,7.2855QALYs could be gained per HIV patient on average via HIV testing strategy in Guangzhou, and the cost of obtaining one QALY was15,740Yuan.Conclusion:It was cost-effective to carry out the expanded HIV testing strategy in Guangzhou from2006to2011. The cost effectiveness ratio of HIV testing strategy in Guangzhou was significantly lower than the standard of WHO recommended, and it was cost-effective to carry out the HIV testing strategy in Guangzhou.