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Economic Evaluation of HIV Testing Among Intravenous Drug Users: An Analytic Framework and Its Application to Italy

Published online by Cambridge University Press:  10 March 2009

Paolo Villari ,
Giovanni Fattore ,
Joanna E. Siegel ,
A. David Paltiel  and
Milton C. Weinstein
Paolo Villari
Affiliation:
Federico II University Medical School
Giovanni Fattore
Affiliation:
L. Bocconi University
Joanna E. Siegel
Affiliation:
Harvard School of Public Health
A. David Paltiel
Affiliation:
Harvard School of Public Health
Milton C. Weinstein
Affiliation:
Harvard School of Public Health
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Abstract

We performed an economic evaluation of HIV testing among intravenous drug users (IVDUs) in Italy using the analytical framework of cost-effectiveness analysis. A semi-Markov model was developed to calculate costs and life expectancy of a cohort of IVDUs with and without an annual HIV testing program. We also investigated the incremental cost-effectiveness of a hypothetical early treatment to prolong the life expectancy of HIV-infected asymptomatic subjects by 1 year. The testing program is cost saving in the low prevalence scenario (0.05), and costs L 14,000,000 (US $8,400) and L 55,800,000 (US $33,500) per year of life saved in areas of medium (0.3) and high (0.6) prevalence, respectively. The incremental cost-effectiveness of the hypothetical early treatment may compare favorably with other health care interventions. The program may be considered a cost-effective procedure in low and medium prevalence areas. Where prevalence is high, more evidence about the magnitude of the behavior change is needed. In these areas, the availability of an effective early treatment may become the economic rationale for implementing such a program.

Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 12 , Issue 2 , Spring 1996 , pp. 336 - 357
Copyright
Copyright © Cambridge University Press 1996

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References

REFERENCES

1.Aboulker, J. P., & Swart, A. M.Preliminary analysis of the Concorde trial. Lancet, 1993, 341, 889–90.CrossRefGoogle ScholarPubMed
2.Allen, D. M., Onorato, I., Green, T. A., & the Field Services Branch of the Centers for Disease Control. HIV infection in intravenous drug users entering drug treatment, United States, 1988 to 1989. American Journal of Public Health, 1992, 82, 541–46.CrossRefGoogle ScholarPubMed
3.Anderson, R. M., Gupta, S., & May, R. M.Potential of community-wide chemotherapy or immunotherapy to control the spread of HIV-1. Nature, 1991, 350, 356–59.CrossRefGoogle ScholarPubMed
4.Angarano, G., Pastore, G., Monno, L., et al. Rapid spread of HTLV-III infection among drug addicts in Italy. Lancet, 1985, 2, 1302.CrossRefGoogle ScholarPubMed
5. Atto di Intesa tra Stato e Regioni del 7.11.1991. Definizione di indirizzi ai fini di un organica distribuzione dei compiti tra le strutture ospedaliere e i servizi territoriali nelle attivita' di prevenzione ed assistenza delle infezioni da HIV. Gazzetta Ufficiale n. 285 del 5.12.1991, Serie generate.Google Scholar
6.Biggar, R. J., & the International Registry of Seroconverters. AIDS incubation in 1891 HIV seroconverters from different exposure groups. AIDS, 1990, 4, 1059–65.CrossRefGoogle ScholarPubMed
7.Booth, R. E., & Watters, J. K.How effective are risk reduction interventions targeting injecting drug users? AIDS, 1994, 8, 1515–24.CrossRefGoogle ScholarPubMed
8.Brenner, M., Ognibene, F. P., Lack, E. E., et al. Prognostic factors and life expectancy of patients with acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia. American Reviews of Respiratory Diseases, 1987, 136, 1199–206.CrossRefGoogle ScholarPubMed
9.Calsyn, D. A., Saxon, A. J., Freeman, G., & Whittaker, S.Ineffectiveness of AIDS education and HIV antibody testing in reducing high risk behaviors among injection drug users. American Journal of Public Health, 1992, 82, 573–75.CrossRefGoogle ScholarPubMed
10.Centers for Disease Control. Diagnosis and management of mycobacterial infection and disease in persons with human T-lymphotropic virus type III lymphadenopathy-associated virus infection. MMWR, 1986, 35, 448–52.Google Scholar
11.Centers for Disease Control. Revision of the CDC surveillance case definition for acquired immunodeficiency syndrome. MMWR, 1987, 36, 3S–9S.Google Scholar
12.CeRGAS. Assistenza ospedaliera 1987. Milano: Università Bocconi, 1988.Google Scholar
13.Choi, K. H., & Coates, T. J.Prevention of HIV infection. AIDS, 1994, 8, 1371–89.CrossRefGoogle ScholarPubMed
14. Circolare Ministero della Sanita' n. 48 del 25.11.1985. Misuredi prevenzione della diffusione della sindrome da immunodeficienza acquisita tra i tossicodipendenti. Gazzetta Ufficilale n. 9 del 13.1.1986, Serie generale.Google Scholar
15.Cleary, P. D., Barry, M. J., Mayer, K. H., et al. Compulsory premarital screening for the human immunodeficiency virus. Journal of American Medical Association, 1987, 258, 1757–62.CrossRefGoogle ScholarPubMed
16.Coates, T. J., Stall, R. D., Kegeles, S. M., et al. AIDS antibody testing: Will it stop the AIDS epidemic? Will it help people infected with HIV? American Psychologist, 1988, 43, 859–64.CrossRefGoogle ScholarPubMed
17.Concorde Coordinating Committee. Concorde: MRC/ANRS randomized double blind controlled trial of immediate and deferred zidovudine in symptom-free HIV infection. Lancet, 1994, 343, 871–81.CrossRefGoogle Scholar
18.Cooper, D. A., Gatell, J. M., Kroon, S., et al. Zidovudine in persons with asymptomatic HIV infection and CD4 cell counts greater than 400 per cubic millimeter. New England Journal of Medicine, 1993, 329, 297–303.CrossRefGoogle ScholarPubMed
19.Cosier, L. E., & Lambrinos, J.Zidovudine's impact on resource use by patients with symptomatic HIV illness: A large sample analysis. Inquiry, 1992, 29, 345–55.Google Scholar
20. Decreto Ministero della Sanita' n.80 del 7.11.1991. Revisione del nomenclatore tariffario delle prestazioni specialistiche ambulatoriali. Supplemento ordinario alia Gazzetta Ufficiale n. 286 del 6 Dicembre 1991, Serie generale.Google Scholar
21. Decreto del Presidente della Repubblica del 7.4.1994. Approvazione del Progetto Obiettivo ‘AIDS 1994–1996’. Gazzetta Ufficiale n. 93 del 22.4.1994, Serie generale.Google Scholar
22.De Rose, A., & Bozuffi, L. Ministero della Sanita': Servizio Centrale per le Dipendenze da Alcool, Sostanze stupefacenti e psicotrope. La rilevazione statistica delle tossicodipen denze: anno 1993 e andamenti temporali. Bollettino per le Farmacodipendenze e I'Alcoo lismo, 1994, XVII, 77–88.Google Scholar
23.Des Jarlais, D. C.Effectiveness of AIDS educative programs for intravenous drug user. Report prepared for the Office of Technology Assessment, U.S. Congress, 1988.Google Scholar
24.Des Jarlais, D. C.The first and second decades of AIDS among injecting drug users. British Journal of Addiction, 1992, 87, 347–53.CrossRefGoogle ScholarPubMed
25.Drummond, M. F., Stoddart, G. L., & Torrance, G. W.Methods for the economic evaluation of health care programmes. Oxford: Oxford Medical Press, 1987.Google Scholar
26.Farci, P., Novick, D. M., Lai, E., et al. Introduction of human immunodeficiency virus infection among parental drug abusers in Sardinia: A seroepidemiological study. American Journal of Epidemiology, 1988, 127, 1312–14.CrossRefGoogle Scholar
27.Freedberg, K. A., Tosteson, A. N. A., Cohen, C. J., & Cotton, D. J.Primary prophylaxis for Pneumocystis carinii pneumonia in HIV-infected people with CD4 counts below 200/mmc: A cost-effectiveness analysis. Journal of Acquired Immunodeficiency Syndrome, 1991, 4, 521–31.Google Scholar
28.Greco, D., Declich, S., & Pezzotti, P.Hospital use by HIV patients in Italy: A retrospective longitudinal study. Journal of Acquired Immunodeficiency Syndrome, 1991, 4, 471–79.Google ScholarPubMed
29.Hamilton, J. D., Hartigan, P. M., Simberkoff, M. S., et al. A controlled trial of early treatment versus late treatment with zidovudine in symptomatic human immunodeficiency virus infection. New England Journal of Medicine, 1992, 324, 1412–16.Google Scholar
30.Henderson, D. K., Fahey, B. J., Willy, M., et al. Risk of occupational transmission of human immunodeficiency virus type 1 (HIV-1) associated with clinical exposures. Annals of Internal Medicine, 1990, 113, 740–46.CrossRefGoogle ScholarPubMed
31.Istituto Superiore di Sanita'. Aggiornamento dei casi di AIDS conclamato notificati in Italia al 31 Dicembre 1990. Ministero della Sanita', Roma, 1991.Google Scholar
32.Jewett, J. F., & Hecht, F. M.Preventive health care for adults with HIV infection. Journal of American Medical Association, 1993, 269, 1144–53.CrossRefGoogle ScholarPubMed
33.Kaplan, E. H.Needles that kill: Modeling human immunodeficiency virus transmission via shared drug injection equipment in shooting galleries. Reviews of Infectious Diseases, 1989, 11, 289–98.CrossRefGoogle ScholarPubMed
34.Krumholz, H. M., Sullam, P. M., & Tager, I. B. Predictors of mortality in patients with AIDS and Pneumocystis carinii pneumonia (PCP). In Program and abstracts of the Fifth International Conference on AIDS, 06 4–9,1989, Montreal, Quebec. Abstract MBP375.Google Scholar
35.Legge, n. 135 del 5.6.1990. Programma di interventi urgenti per la prevenzione e la lotta contro l'AIDS. Gazzetta Ufficiale n. 132 dell' 8.6.1990, Serie generate.Google Scholar
36.L'Informatorefarmaceutico 1993. Organizzazione EditorialeMedico-Farmaceutica, 1993.Google Scholar
37.Lipsky, J. J.Concorde lands. Lancet, 1994, 343, 866–67.CrossRefGoogle ScholarPubMed
38.Lundgren, J. D., Phillips, A. N., Pedersen, C., et al. Comparison of long-term prognosis of patients with AIDS treated and not treated with zidovudine. Journal of the American Medical Association 1994, 271, 1088–92.CrossRefGoogle Scholar
39.Mariotto, A. B., Mariotti, S., Pezzotti, P., et al. Estimation of the acquired immunodefi ciency syndrome incubation period in intravenous drug users: A comparison with male homosexuals. American Journal of Epidemiology, 1992, 135, 428–37.CrossRefGoogle Scholar
40.May, R. M., & Anderson, R. M.Transmission dynamics of HIV infection. Nature, 1987, 326, 137–2.CrossRefGoogle ScholarPubMed
41.McLeod, G. X., & Hammer, S. M.Zidovudine: Five years later. Annals of Internal Medicine, 1992, 117, 487–501.CrossRefGoogle ScholarPubMed
42.Nicolosi, A., Lea' Correa Leite, M., Molinari, S., et al. Incidence and prevalence trends of HIV infection in intravenous drug users attending treatment centers in Milan and northern Italy, 1986/1990. Journal of Acquired Immunodeficiency Syndrome, 1992, 5, 365–73.Google ScholarPubMed
43.Paltiel, A. D., & Kaplan, E. H.Modeling zidovudine therapy: A cost-effectiveness analysis. Journal of Acquired Immunodeficiency Syndrome, 1991, 4, 795–804.Google ScholarPubMed
44.Perucci, C. A., Davoli, M., Rapiti, E., et al. Mortality of intravenous drug users in Rome: A cohort study. American Journal of Public Health, 1991, 81, 1307–09.CrossRefGoogle ScholarPubMed
45.Peto, R., & Collins, R.Immediate versus deferred zidovudine. Lancet 1993, 341,1022–23.CrossRefGoogle ScholarPubMed
46.Rezza, G., De Rose, A., De Robert, D., & Serafin, I.Diffusione dell'infezione da HIV nei tossicodipendenti afferenti ai servizi d'assistenza pubblici in Italia: 1990. L'Igiene Moderna, 1992, 98, 739–51.Google Scholar
47.Romano, N., Vitale, F., Alesi, D. R., et al. The changing pattern of human immunodeficiency virus type 1 infection in intravenous drug users: Results of a six-years seroprevalence study in Palermo, Italy. American Journal of Epidemiology, 1992, 135, 1189–96.CrossRefGoogle Scholar
48.Saah, A. J.Immediate versus deferred zidovudine. Lancet, 1993, 341, 1023.Google ScholarPubMed
49.Salmaso, S., Conti, S., Sasse, H., & the Second Multicenter Study Group on Drug Users. Drug use and HIV-1 infection: Report from the Second Italian Multicenter Study. Journal of Acquired Immunodeficiency Syndrome, 1991, 4, 607–13.Google ScholarPubMed
50.Sasse, H., Salmaso, S., & Conti, S.Risk behaviors for HIV-1 infection in Italian drug users: Reports from a multicenter study. Journal of Acquired Immunodeficiency Syndrome, 1989, 2, 486–96.Google ScholarPubMed
51.Schulman, K. A., Lynn, L. A., Glick, H. A., & Eisemberg, J. M.Cost effectiveness of low dose zidovudine therapy for asymptomatic patients with human immunodeficiency virus (HIV) infection. Annals of Internal Medicine, 1991, 114, 798–802.CrossRefGoogle ScholarPubMed
52.Schwartz, J. S., Kinosian, B. P., Pierskalla, W. P., & Lee, H.Strategies for screening blood for human immunodeficiency virus antibody. Journal of American Medical Association, 1990, 264, 1704–10.CrossRefGoogle ScholarPubMed
53.Siegel, J. E., Weinstein, M. C., & Fineberg, H. V.Bleach programs for preventing AIDS among IV drug users: Modeling the impact of HIV prevalence. American Journal of Public Health, 1991, 81, 1273–79.CrossRefGoogle ScholarPubMed
54.Turner, C. F., Miller, H. G., & Moses, L. E. AIDS: Sexual behavior and intravenous drug use. Washington, DC: National Academy Press, 1989.Google Scholar
55.U.S. Preventive Services Task Force. Guide to clinical preventive services: An assessment of the effectiveness of 169 interventions. Baltimore, MD: Williams & Wilkins, 1989.Google Scholar
56.Van den Hoek, A. R., von Haastrecht, H. J. A., & Coutinho, R. A.Risk reduction among intravenous drug users in Amsterdam under the influence of AIDS. American Journal of Public Health, 1989, 79, 1355–57.CrossRefGoogle ScholarPubMed
57.Vella, S., Giuliano, M., Pezzotti, P., et al. Survival of zidovudine-treated patients with AIDS compared with that of contemporary untreated patients. Journal of American Medical Association, 1992, 267, 1232–36.CrossRefGoogle ScholarPubMed
58.Visco Comandini, V.II trettamento ospedaliero dei pazienti affetti da AIDS: Un'analisi economica. Economia pubblica, 1992, 22, 285–95.Google Scholar
59.Volberding, P. A., Lagakos, S. W., Koch, M. A., et al. Zidovudine in asymptomatic human immunodeficiency virus infection. New England Journal of Medicine, 1990, 322, 941–49.CrossRefGoogle ScholarPubMed
60.Von Ameijden, R. J. C., Van den Hoek, A. R., & Coutinho, R. A.Injecting risk behavior among drug users in Amsterdam, 1986 to 1992, and its relationship to AIDS prevention programs. American Journal of Public Health, 1994, 84, 275–81.CrossRefGoogle Scholar
61.Zaccarelli, M., Rezza, G., Girardi, E., et al. Monitoring HIV trends in injecting drug users: An Italian experience. AIDS, 1990, 4, 1007–10.CrossRefGoogle ScholarPubMed