Phillips, Andrew NAndrew NPhillipsCambiano, ValentinaValentinaCambianoNakagawa, FumiyoFumiyoNakagawaBansi-Matharu, LoveleenLoveleenBansi-MatharuWilson, DavidDavidWilsonJani, IleshIleshJaniApollo, TsitsiTsitsiApolloSculpher, MarkMarkSculpherHallett, TimothyTimothyHallettKerr, CliffCliffKerrvan Oosterhout, Joep JJoep Jvan OosterhoutEaton, Jeffrey WJeffrey WEatonEstill, Janne Anton MarkusJanne Anton MarkusEstillWilliams, BrianBrianWilliamsDoi, NaokoNaokoDoiCowan, FrancesFrancesCowanKeiser, OliviaOliviaKeiserFord, DeborahDeborahFordHatzold, KarinKarinHatzoldBarnabas, RuanneRuanneBarnabasAyles, HelenHelenAylesMeyer-Rath, GesineGesineMeyer-RathNelson, LisaLisaNelsonJohnson, CherylCherylJohnsonBaggaley, RachelRachelBaggaleyFakoya, AdeAdeFakoyaJahn, AndreasAndreasJahnRevill, PaulPaulRevill2024-10-282024-10-282019-07https://boris-portal.unibe.ch/handle/20.500.12422/181251INTRODUCTION As prevalence of undiagnosed HIV declines, it is unclear whether testing programmes will be cost-effective. To guide their HIV testing programmes, countries require appropriate metrics that can be measured. The cost-per-diagnosis is potentially a useful metric. METHODS We simulated a series of setting-scenarios for adult HIV epidemics and ART programmes typical of settings in southern Africa using an individual-based model and projected forward from 2018 under two policies: (i) a minimum package of "core" testing (i.e. testing in pregnant women, for diagnosis of symptoms, in sex workers, and in men coming forward for circumcision) is conducted, and (ii) core-testing as above plus additional testing beyond this ("additional-testing"), for which we specify different rates of testing and various degrees to which those with HIV are more likely to test than those without HIV. We also considered a plausible range of unit test costs. The aim was to assess the relationship between cost-per-diagnosis and the incremental cost-effectiveness ratio (ICER) of the additional-testing policy. The discount rate used in the base case was 3% per annum (costs in 2018 U.S. dollars). RESULTS There was a strong graded relationship between the cost-per-diagnosis and the ICER. Overall, the ICER was below $500 per-DALY-averted (the cost-effectiveness threshold used in primary analysis) so long as the cost-per-diagnosis was below $315. This threshold cost-per-diagnosis was similar according to epidemic and programmatic features including the prevalence of undiagnosed HIV, the HIV incidence and a measure of HIV programme quality (the proportion of HIV diagnosed people having a viral load <1000 copies/mL). However, restricting to women, additional-testing did not appear cost-effective even at a cost-per-diagnosis of below $50, while restricting to men additional-testing was cost-effective up to a cost-per-diagnosis of $585. The threshold cost per diagnosis for testing in men to be cost-effective fell to $256 when the cost-effectiveness threshold was $300 instead of $500, and to $81 when considering a discount rate of 10% per annum. CONCLUSIONS For testing programmes in low-income settings in southern African there is an extremely strong relationship between the cost-per-diagnosis and the cost-per-DALY averted, indicating that the cost-per-diagnosis can be used to monitor the cost-effectiveness of testing programmes.enHIV cost-effectiveness health systems modelling testing300 - Social sciences, sociology & anthropology::360 - Social problems & social services500 - Science::510 - Mathematicsarticle10.7892/boris.1320143128762010.1002/jia2.25325