Abstract
IntroductionThis study reviewed the economic evidence of rapid HIV testing versus conventional HIV testing in low-prevalence high-income countries; evaluated the methodological quality of existing economic evaluations of HIV testing studies; and made recommendations on future economic evaluation directions of HIV testing approaches.MethodsA systematic search of selected databases for relevant English language studies published between Jan 1, 2001, and Jan 30, 2019, was conducted. The methodological design quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and the Drummond tool. We reported the systematic review according to the PRISMA guidelines.ResultsFive economic evaluations met the eligibility criteria but varied in comparators, evaluation type, perspective, and design. The methodologic quality of the included studies ranged from medium to high. We found evidence to support the cost-effectiveness of rapid HIV testing approaches in low-prevalence high-income countries. Rapid HIV testing was associated with cost per adjusted life year (QALY), ranging from $42,768 to $90,498. Additionally, regardless of HIV prevalence, rapid HIV testing approaches were the most cost-effective option.ConclusionsThere is evidence for the cost-effectiveness of rapid HIV testing, including the use of saliva-based testing compared to usual care or hospital-based serum testing. Further studies are needed to draw evidence on the relative cost-effectiveness of the distinct options and contexts of rapid HIV testing.
Highlights
This study reviewed the economic evidence of rapid Human immunodeficiency virus (HIV) testing versus conventional HIV testing in lowprevalence high-income countries; evaluated the methodological quality of existing economic evaluations of HIV testing studies; and made recommendations on future economic evaluation directions of HIV testing approaches
Recent UNAIDS data shows that about 50% of people living with HIV are unaware of their diagnosis; Medu et al Health Economics Review (2021) 11:19 for example, Canada, France, Spain and the United States report a substantial proportion of undiagnosed HIV cases [9,10,11,12,13]
This review focuses on the strength and quality of evidence addressing the cost-effectiveness of rapid HIV testing approaches versus conventional testing approaches in managing HIV infection
Summary
This study reviewed the economic evidence of rapid HIV testing versus conventional HIV testing in lowprevalence high-income countries; evaluated the methodological quality of existing economic evaluations of HIV testing studies; and made recommendations on future economic evaluation directions of HIV testing approaches. HIV testing, early diagnosis and effective treatment improve outcomes significantly for infected individuals and the communities they live [6, 7]. This premise forms the foundation for the highly effective “treatment as prevention” approach [2, 8]. Recent UNAIDS data shows that about 50% of people living with HIV are unaware of their diagnosis; Medu et al Health Economics Review (2021) 11:19 for example, Canada, France, Spain and the United States report a substantial proportion of undiagnosed HIV cases [9,10,11,12,13]. Rates of undiagnosed HIV tend to be higher among men who have sex with men, youth and minority population groups [11]
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