Cost-effectiveness of Frequent HIV Screening Among High-risk Young Men Who Have Sex With Men in the United States

• Published in: Clinical infectious diseases Vol. 73; no. 7; pp. e1927 - e1935
• Main Authors: Neilan, Anne M, Bulteel, Alexander J B, Hosek, Sybil G, Foote, Julia H A, Freedberg, Kenneth A, Landovitz, Raphael J, Walensky, Rochelle P, Resch, Stephen C, Kazemian, Pooyan, Paltiel, A David, Weinstein, Milton C, Wilson, Craig M, Ciaranello, Andrea L
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 05.10.2021
• Subjects: Adolescent; Adult; CD4 Lymphocyte Count; Cost-Benefit Analysis; HIV Infections - diagnosis; HIV Infections - drug therapy; HIV Infections - epidemiology; Homosexuality, Male; Humans; Male; Online Only; Quality-Adjusted Life Years; Sexual and Gender Minorities; United States - epidemiology; Young Adult; United States; cost-effectiveness; Young men who have sex with men; screening; HIV; adolescents and young adults
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciaa1061

Of new HIV infections in the US, 20% occur among young men who have sex with men (YMSM, ages 13-24), but >50% of YMSM with HIV are unaware of their status. Using Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) data, we projected the clinical benefit and cost-effectiveness of frequent HIV screening among high-risk YMSM from age 15. Using a mathematical simulation, we examined 3 screening strategies: Yearly, 6-monthly, and 3-monthly, each in addition to the Status quo (SQ, 0.7-10.3% screened/year, stratified by age). We used published data (YMSM-specific when available) including: HIV incidences (0.91-6.41/100PY); screen acceptance (80%), linkage-to-care/antiretroviral therapy (ART) initiation (76%), HIV transmission (0.3-86.1/100PY, by HIV RNA), monthly ART costs ($2290-$3780), and HIV per-screen costs ($38). Projected outcomes included CD4 count at diagnosis, primary HIV transmissions from ages 15-30, quality-adjusted life expectancy, costs, and incremental cost-effectiveness ratios (ICERs, $/quality-adjusted life-year saved [QALY]; threshold ≤$100 000/QALY). Compared to SQ, all strategies increased projected CD4 at diagnosis (296 to 477-515 cells/µL) and quality-adjusted life expectancy from age 15 (44.4 to 48.3-48.7 years) among YMSM acquiring HIV. Compared to SQ, all strategies increased discounted lifetime cost for the entire population ($170 800 to $178 100-$185 000/person). Screening 3-monthly was cost-effective (ICER: $4500/QALY) compared to SQ and reduced primary transmissions through age 30 by 40%. Results were most sensitive to transmission rates; excluding the impact of transmissions, screening Yearly was ≤$100 000/QALY (ICER: $70 900/QALY). For high-risk YMSM in the US, HIV screening 3-monthly compared to less frequent screening will improve clinical outcomes and be cost-effective.