Cost‐effectiveness analysis of integrating screening and treatment of selected non‐communicable diseases into HIV/AIDS treatment in Uganda

作者：David Sando, Alexander Kintu, Samson Okello, Peter Chris Kawungezi, David Guwatudde, Gerald Mutungi, Winnie Muyindike, Nicolas A. Menzies, Goodarz Danaei, Stéphane Verguet · 发表于：Journal of the International AIDS Society · 年份：2020 · DOI：10.1002/jia2.25507 · 被引用次数：46 · 研究领域：HIV-related health complications and treatments、HIV/AIDS Research and Interventions、Diabetes, Cardiovascular Risks, and Lipoproteins

INTRODUCTION: Despite growing enthusiasm for integrating treatment of non-communicable diseases (NCDs) into human immunodeficiency virus (HIV) care and treatment services in sub-Saharan Africa, there is little evidence on the potential health and financial consequences of such integration. We aim to study the cost-effectiveness of basic NCD-HIV integration in a Ugandan setting. METHODS: We developed an epidemiologic-cost model to analyze, from the provider perspective, the cost-effectiveness of integrating hypertension, diabetes mellitus (DM) and high cholesterol screening and treatment for people living with HIV (PLWH) receiving antiretroviral therapy (ART) in Uganda. We utilized cardiovascular disease (CVD) risk estimations drawing from the previously established Globorisk model and systematic reviews; HIV and NCD risk factor prevalence from the World Health Organization's STEPwise approach to Surveillance survey and global databases; and cost data from national drug price lists, expert consultation and the literature. Averted CVD cases and corresponding disability-adjusted life years were estimated over 10 subsequent years along with incremental cost-effectiveness of the integration. RESULTS: Integrating services for hypertension, DM, and high cholesterol among ART patients in Uganda was associated with a mean decrease of the 10-year risk of a CVD event: from 8.2 to 6.6% in older PLWH women (absolute risk reduction of 1.6%), and from 10.7 to 9.5% in older PLWH men (absolut...