HIV自检模式在男男性行为者中的成本效果分析

Cost-effectiveness of HIV self-testing strategy in men who have sex with men

目的分析珠海市MSM中HIV自我检测(HIVST)模式和现场HIV快速检测(HIV-RDT)模式的成本效果和支付意愿,为政府合理配置卫生资源提供参考依据。方法以卫生服务提供者的视角,收集珠海市在2019年1-9月MSM参与两种HIV检测模式的成本投入和效果产出,采用TreeAge Pro 2019软件构建10000名MSM队列决策树模型,测算成本效果比(CER)和增量成本效果比(ICER),以敏感性分析模型中各参数的不确定性,绘制成本效果可支付曲线评价策略的可支付性。结果珠海市男同社会组织通过互联网+社交媒体动员参与HIVST和现场HIV-RDT的MSM人次数为2303 vs.816,发现HIV筛查阳性者人数为33 vs.35,筛查阳性率为1.7%vs.4.3%。每筛查1例的成本为60.45元vs.240.43元,每发现1例筛查阳性的成本为4218元vs.5606元。决策树模型运行结果显示,每检测1例MSM的平均费用为44.67元vs.148.42元,ICER为负值。当发现1例HIV筛查阳性支付意愿低于6528元时,HIVST更具成本效果的选择;当投入高于该阈值时,现场HIV-RDT是更具成本效果的选择。结论珠海市现行的HIVST模式是具有经济学价值的公共卫生项目,决策者应加大社会组织扶持力度,推广HIVST在MSM中的应用。

Objective To analyze the cost-effectiveness and willingness-to-pay of HIV self-testing(HIVST)strategy and facility-based HIV rapid testing(HIV-RDT)strategy in men who have sex with men(MSM)in Zhuhai,and provide scientific evidence for making health policy.Methods From the perspective of health service providers,the data of the costs and effectiveness of two HIV testing strategies in MSM in Zhuhai during January-September 2019 were collected,and a decision-tree model of cohort of 10000 MSM was constructed by using software TreeAge Pro 2019 to measure the cost-effectiveness ratio(CER)and the incremental cost-effectiveness ratio(ICER).One-way and probability sensitivity analysis was performed for the uncertainty of the parameters in the model,and the cost-effectiveness and affordability curve was introduced to estimate the affordability of two strategies.Results After the mobilization of MSM community-based organization through Internet and social media,2303 MSM had HIVST,in whom 33 were HIV positive(1.7%),and 816 MSM received HIV-RDT,in whom 35 were HIV positive(4.3%).The cost for per screening was 60.45 yuan and 240.43 yuan(RMB)respectively,and the cost for per positive screening was 4218 yuan and 5606 yuan(RMB)rerspectively.The results of the decision-tree model showed that the mean cost for a MSM using HIVST and using HIV-RDT was 44.67 yuan and 148.42 yuan(RMB)respectively,and the ICER was negative.HIVST strategy was a more cost-effective option when the willing-to-pay was below 6528 yuan(RMB)for per positive screening,and HIV-RDT strategy was a more cost-effective option when the investment was higher than 6528 yuan(RMB).Conclusion HIVST strategy in Zhuhai is a public health project with economic value,and policy makers should strengthen the support to MSM community-based organization to promote the application of HIVST among MSM.