Assessment of the Potential Impact and Cost-effectiveness of Self-Testing for HIV in Low-Income Countries
Cambiano, V.; Ford, D.; Mabugu, T.; Napierala Mavedzenge, S.; Miners, A.; Mugurungi, O.; Nakagawa, F.; Revill, P.; Phillips, A.
Journal of Infectious Diseases 212(4): 570-577
2015
ISSN/ISBN: 1537-6613 PMID: 25767214 DOI: 10.1093/infdis/jiv040Document Number: 640319
Studies have demonstrated that self-testing for human immunodeficiency virus (HIV) is highly acceptable among individuals and could allow cost savings, compared with provider-delivered HIV testing and counseling (PHTC), although the longer-term population-level effects are uncertain. We evaluated the cost-effectiveness of introducing self-testing in 2015 over a 20-year time frame in a country such as Zimbabwe. The HIV synthesis model was used. Two scenarios were considered. In the reference scenario, self-testing is not available, and the rate of first-time and repeat PHTC is assumed to increase from 2015 onward, in line with past trends. In the intervention scenario, self-testing is introduced at a unit cost of $3. We predict that the introduction of self-testing would lead to modest savings in healthcare costs of $75 million, while averting around 7000 disability-adjusted life-years over 20 years. Findings were robust to most variations in assumptions; however, higher cost of self-testing, lower linkage to care for people whose diagnosis is a consequence of a positive self-test result, and lower threshold for antiretroviral therapy eligibility criteria could lead to situations in which self-testing is not cost-effective. This analysis suggests that introducing self-testing offers some health benefits and may well save costs.