Cost-Effectiveness of Voluntary HIV Testing Strategies in a Very Low-Prevalence Country, the Republic of Korea

• Published in: Journal of Korean medical science Vol. 33; no. 46; pp. e304 - 7
• Main Authors: Lee, Young Hwa, Bang, Ji Hwan, Park, Sang Min, Kang, Cho Ryok, Cho, Sung-Il, Oh, Myoung-Don, Lee, Jong-Koo
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Academy of Medical Sciences 12.11.2018; 대한의학회
• Subjects: AIDS Serodiagnosis - economics; Cost-Benefit Analysis; Decision Making; Enzyme-Linked Immunosorbent Assay - economics; HIV Infections - economics; HIV Infections - epidemiology; Humans; Mass Screening - economics; Original; Prevalence; Public Health; Reagent Kits, Diagnostic - economics; Republic of Korea; Risk; Serologic Tests; 의학일반; Republic of Korea; HIV Screening Test; Cost-effectiveness Analysis; Korea
• ISSN: 1011-8934; 1598-6357
• DOI: 10.3346/jkms.2018.33.e304

The Republic of Korea has a very low prevalence of human immunodeficiency virus (HIV) infection, but the number of new HIV diagnoses has steadily risen, strongly indicating a large number of undetected HIV infections. Thus, it is important for Korean public health authorities to adopt and encourage cost-effective HIV detection tools, such as rapid HIV screening tests. In this study, we aimed to evaluate the cost-effectiveness of enzyme-linked immunosorbent assays (ELISA) and rapid tests in a public health center (PHC) setting. We developed a decision analytic model to assess the per-examinee cost and the cost-effectiveness of identifying HIV patients in a PHC setting using two HIV testing strategies: conventional HIV screening by ELISA versus rapid HIV testing. Analysis was performed in two scenarios: HIV testing in an average-risk population and in a high-risk population. Compared to the ELISA, the rapid test was cost-saving and cost-effective. The per-examinee cost was USD 1.61 with rapid testing versus USD 3.38 with ELISA in an average-risk population, and USD 4.77 with rapid testing versus USD 7.62 with ELISA in a high-risk population. The cost of identifying a previously undiagnosed HIV case was USD 26,974 with rapid testing versus USD 42,237 with ELISA in an average-risk population, and USD 153 with rapid testing versus USD 183 with ELISA in a high-risk population. Rapid testing would be more cost-effective than using conventional ELISA testing for identifying previously undiagnosed HIV-infected cases in Korea, a country with extremely low HIV prevalence.