Cost-effectiveness of increased hiv testing among MSM in the netherlands.

Abstract

To assess the cost-effectiveness of increased consistent HIV testing among men who have sex with men (MSM) in the Netherlands. Among MSM testing at STI clinics in the Netherlands in 2014-2015, approximately 20% tested consistently every six months. We examined four scenarios with increased percentage of MSM testing every six months: a small and a moderate increase among all MSM; a small and a moderate increase only among MSM with ≥10 partners in the preceding six months. We used an agent-based model to calculate numbers of HIV infections and AIDS cases prevented with increased HIV testing. These numbers were used in an economic model to calculate costs, quality-adjusted life-years (QALY), and incremental cost-effectiveness ratios (ICER) due to increased testing, over 2018-2027, taking a healthcare payer perspective. A small increase in the percentage testing every six months among all MSM resulted in 490 averted HIV infections and an average ICER of &OV0556;27,900/QALY gained. A moderate increase among all MSM, resulted in 1380 averted HIV infections and an average ICER of &OV0556;36,700/QALY gained. Both were not cost-effective, with a &OV0556;20,000 willingness-to-pay threshold. Increasing the percentage testing every six months only among MSM with ≥10 partners in the preceding six months resulted in less averted HIV infections than increased testing among all MSM, but was on average cost-saving. Increased HIV testing can prevent considerable numbers of new HIV infections among MSM, but may be cost-effective only if targeted at high-risk individuals, such as those with many partners.