HIV Screening in Primary Care Proves Cost-Effective in Areas of High Prevalence

General practitioners (GPs) may have a larger role to play in the fight against HIV and the opportunity to save hundreds of lives, according to a new study recently published in The Lancet HIV.

The authors found that introducing HIV screening in primary care offices has the potential to save lives and decrease the costs associated with treatment by increasing rates of early diagnosis. As a result of their findings, the authors are appealing to health care commissioners throughout England to include HIV screening capabilities in 74 local authorities throughout the country which are known to have a high prevalence of HIV infections (indicated as those authorities with > 2 diagnosed HIV infections per 1000 adults.)

Compared with even a decade ago, individuals who are now diagnosed with HIV can expect to have a normal life expectancy, particularly if the infection is diagnosed early and the individual starts treatment as soon as possible. However, this can only happen if an individual is aware of their status. In the United Kingdom alone, some 13,500 individuals still do not know that they are HIV+, according to a press release on the Lancet study. These individuals are missing out on treatment and will be more expensive to treat in the future.

Therefore, those involved with planning for the care of these individuals need to use reliable estimates of the cost of screening. Until the recent Lancet study, however, robust data from randomized clinical trials has not been available.

For their study, the researchers used data from a previous research trial completed in a borough in London with a high prevalence of HIV: Hackney. The rate of infection there is 8 infections per 1000 adults. Data from 40 general practices, “where they tested the effect of rapid finger-prick HIV testing as part of the standard health check during registration,” was used, according to the press release. The results showed that GP-screening led to a 4-fold higher HIV diagnosis rate. Despite the successful increase in diagnosis, the researchers needed to know if adding testing at these facilities would increase the overall cost of HIV testing and treatment.

To determine if adding HIV screening at the GP level would increase costs, the researchers utilized a mathematical model that, according to the press release, “include[ed] all the costs associated with HIV testing and treatment,” and showed that, “primary care HIV screening in high prevalence settings becomes cost-effective in 33 years (according to National Institute for Health and Care Excellence [NICE] criteria.”

"Currently NICE uses a threshold of £20,000 to £30,000 per Quality Adjusted Life Year (QALY) gained to gauge whether the health benefits of an intervention offer value for money to the National Health Service (NHS) and its patients. 'QALY' is a widely-used measure of health that combines length and quality of life. We found that over 40 years, primary care-based HIV screening in high prevalence areas would cost an estimated £26,626 per QALY gained and therefore warrants funding in the UK," stated Rebecca Baggaley, PhD, lead author of the study and Honorary Lecturer at the London School of Hygiene & Tropical Medicine in the press release.

In addition, according to the press release, GP-screening for HIV, “may even become cost-saving if the long-term healthcare costs of late-diagnosed patients are much higher than those of patients diagnosed earlier, as has been observed in Canada.”

The 74 authorities that were identified as ones that would benefit from GP-screening for HIV are those with the highest HIV prevalence out of the total 325 authorities in England. A total of 11 authorities were identified as having an HIV prevalence similar to Hackney.

According to the press release, “The estimated annual cost of rolling out the screening program to all 11 Hackney-level HIV prevalence authorities would be approximately £600,000 (£4 million for roll-out to all 74 high prevalence authorities). This does not include increased healthcare costs resulting from earlier HIV diagnosis and treatment which would fall under other National Health Service budgets.”

The authors note that limitations of the study included the fact that, “some data, including probability of viral transmission to partners and quality of life, have been estimated based on international literature and may therefore not accurately reflect the Hackney situation.”