Cost-effectiveness analysis of expanded HIV testing strategy in Taizhou, Zhejiang

Objective To evaluate the expanded HIV detection strategy in Taizhou of Zhejiang province by using the cost-effectiveness analysis, so as to provide evidence of AIDS prevention strategy formulation. Methods Based on field investigation, the implementation of HIV detection strategy in Taizhou during 2009-2013 was investigated by questionnaire survey to collect related cost and effectiveness information. The amount of HIV positive-detected patients and information of follow-up visit were collected through national AIDS comprehensive control data and information system. The Bernoulli-process model was used to calculate the number of infections through sexual transmission avoided by expanded HIV testing strategy. The ratio of cost and effectiveness was regarded as the index to analyze cost effectiveness. Results From 2009 to 2013, the total cost of HIV testing strategy in Taizhou was 43.355 million yuan. A total of 2 798 535 persons were tested, and 1 421 were found HIV infected (5.1/10 000) , among whom 1 164 (81.9%) were included in the follow-up management. The average cost of HIV detection for finding each new case of HIV infection was 30 510.2 yuan, and the average cost of HIV detection for bringing each new case of HIV infection into the follow-up management was 37 246.6 yuan. Based on the Bernoulli-process model, the total number of HIV infections through sexual transmission avoided by expanded HIV testing strategy was about 3 105 (range: 2 525-3 787) persons. The cost effectiveness analysis showed that the average cost of HIV detection for avoiding each new case of HIV infection through sexual transmission was 13 963.0 (range: 11 448.4-17 170.3) yuan. Conclusions The expanded HIV testing strategy has great economic and public health benefits in Taizhou. It is better to further expand the HIV testing strategy in high-risk groups. At the same time, the follow-up management of positive patients needs to be taken into consideration. Key words: HIV; Testing strategy; Cost-effectiveness