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Cost-effectiveness of increased hiv testing among men who have sex with men in the netherlands

Reitsema, Maartena; Steffers, Lindaa,b; Visser, Maartjea; Heijne, Jannekea; HOEK, Albert Jan Vana; Loeff, Maarten Schim Van Derc,d; Van Sighem, Arde; Van Benthem, Birgita; Wallinga, Jaccoa,f; Xiridou, Mariaa; Mangen, Marie-Joseea

doi: 10.1097/QAD.0000000000002199
Original Paper (Basic Science): PDF Only

Objectives: To assess the cost-effectiveness of increased consistent HIV testing among men who have sex with men (MSM) in the Netherlands.

Methods: 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.

Results: A small increase in the percentage testing every six months among all MSM resulted in 490 averted HIV infections and an average ICER of €27,900/QALY gained. A moderate increase among all MSM, resulted in 1380 averted HIV infections and an average ICER of €36,700/QALY gained. Both were not cost-effective, with a €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.

Conclusions: 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.

aDepartment of Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands

bRadboud University Medical Center, Nijmegen, The Netherlands

cDepartment of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands

dDepartment of Internal Medicine, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centre, University of Amsterdam, The Netherlands

eStichting HIV Monitoring, Amsterdam, The Netherlands

fDepartment of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands.

Correspondence to Maarten Reitsema, National Institute of Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands. Tel: +3130-2748547; fax: +3130-274 4409; e-mail:

Received 27 September, 2018

Revised 15 January, 2019

Accepted 4 February, 2019

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