Value of public health interventions for HIV, HBV and HCV integrated screening: The FOCUS-CRIVALVIR programme

Abstract

Introduction

A late diagnosis of human immunodeficiency virus (HIV), hepatitis C virus (HCV) or hepatitis B virus (HBV) increases the chances of transmission and healthcare costs, as well as increases morbidity and the progression of the disease. The aim was to evaluate the impact of FOCUS-CRIVALVIR programme implementation on the transmission of these viruses and the costs in the Valencian Community (3,902,512 adults) compared with nonimplementation.

Methods

A decision tree was developed to estimate the number of individuals screened and their follow-up in healthcare, combined with a transmission model for each virus to evaluate infections and mortality avoided and costs of new infections and late diagnosis. The analysis was carried out in different at-risk populations. The population susceptible to infection, interactions between individuals and the risk of transmission among undiagnosed individuals, untreated and treated without a response are considered.

Results

With FOCUS-CRIVALVIR programme, 440,203 individuals would be screened; 1064-HIV, 1455-HCV and 1627-HBV infections would be diagnosed; and 1053, 1422 and 111 individuals would be treated, respectively. Compared with nonintervention, FOCUS-CRIVALVIR programme would avoid 464 new HIV, 524 new HCV and 169 new HBV infections within 20 years and reduce mortality. The programme would cost 6 million euros (€M) to implement but would save € 154 M (€ 152 M infections avoided and € 8 M late diagnosis less cost programme) vs nonintervention.

Conclusions

The implementation of the FOCUS-CRIVALVIR programme would enable early access to the diagnosis and treatment of HIV, HCV and HBV; reduce the transmission, mortality, and costs of new infections and late diagnosis; and add value to society and the healthcare system.