Cost-effectiveness of facility-based, stand-alone and mobile-based voluntary counseling and testing for HIV in Addis Aba
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Cost Effectiveness and Resource Allocation Open Access
RESEARCH
Cost‑effectiveness of facility‑based, stand‑alone and mobile‑based voluntary counseling and testing for HIV in Addis Ababa, Ethiopia Amanuel Yigezu1,3* , Senait Alemayehu3, Shallo Daba Hamusse4, Getachew Teshome Ergeta2, Damen Hailemariam1 and Alemayehu Hailu1,2*
Abstract Background: Globally, there is a consensus to end the HIV/AIDS epidemic by 2030, and one of the strategies to achieve this target is that 90% of people living with HIV should know their HIV status. Even if there is strong evidence of clients’ preference for testing in the community, HIV voluntary counseling and testing (VCT) continue to be undertaken predominantly in health facilities. Hence, empirical cost-effectiveness evidence about different HIV counseling and testing models is essential to inform whether such community-based testing are justifiable compared with additional resources required. Therefore, the purpose of this study was to compare the cost-effectiveness of facility-based, stand-alone and mobile-based HIV voluntary counseling and testing methods in Addis Ababa, Ethiopia. Methods: Annual economic costs of counseling and testing methods were collected from the providers’ perspective from July 2016 to June 2017. Ingredients based bottom-up costing approach was applied. The effectiveness of the interventions was measured in terms of the number of HIV seropositive clients identified. Decision tree modeling was built using TreeAge Pro 2018 software, and one-way and probabilistic sensitivity analyses were conducted by varying HIV positivity rate, costs, and probabilities. Results: The cost of test per client for facility-based, stand-alone and mobile-based VCT was $5.06, $6.55 and $3.35, respectively. The unit costs of test per HIV seropositive client for the corresponding models were $158.82, $150.97 and $135.82, respectively. Of the three models, stand-alone-based VCT was extendedly dominated. Mobile-based VCT costs, an additional cost of USD 239 for every HIV positive client identified when compared to facility-based VCT. Conclusion: Using a mobile-based VCT approach costs less than both the facility-based and stand-alone approaches, in terms of both unit cost per tested individual and unit cost per HIV seropositive cases identified. The stand-alone VCT approach was not cost-effective compared to facility-based and mobile-based VCT. The incremental cost-effectiveness ratio for mobile-based VCT compared with facility-based VCT was USD 239 per HIV positive case. Keywords: Ingredients costing, Decision tree modeling, Reciprocal cost allocation, Cost-effectiveness analysis, VCT models
*Correspondence: [email protected]; [email protected] 1 School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia Full list of author information is available at the end of the article
Background HIV is one of the most devastating global epidemics in human history. Since the beginning of the epidemic, about 78 million people had been infected, and more than 35
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