Prediction of Cost-effectiveness for Human Immunodeficiency Virus (HIV) Screening Program in Japan

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We predicted the cost-effectiveness of undertaking human immunodeficiency virus screening programs in Japan. Effectiveness of antiviral drug, zidovudine as prophylactic treatment for asymptomatic HIV infected persons brought the concept of widespread screening programs. The cost-effectiveness of two strategies : 1) screening and prophylactic treatment for asymptomatic HIV positive person whose T4 cells fall below 500/cubic millimeter and 2) no screening, were compared in different groups of populations (blood donors, homosexuals, and Thai females). The key data such as the life years gained by prophylactic treatment, the prevalence of HIV among different groups, the initial T4 cell count, the time to develop AIDS, and the efficacy of aerosolized pentamidine were obtained from published literatures. The costs were estimated according to the cost book of health care published by Ministry of Health and Welfare of Japan. In the population with prevalence of 1-4%, which includes homosexuals of Tokyo and Thai females, the incremental cost-effectiveness ratio is US 12, 836-13, 333 per life year gained. In the population with very low prevalence such as average blood donors, the incremental cost-effectiveness ratio rises to $1, 444, 092 per life year gained. Comparing with other medical intervention it is found that the HIV screening program for the population with prevalence over 0.1% is cost-effective. Sensitivity analyses which alter each of the variables in the analysis indicate that if the effectiveness of zidovudine is 50% and 25% of the published rate, then the program remains cost-effective at the prevalence rate of 0.5% and 3% respectively. J Epidemiol, 1995; 5 : 35-41.

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