OBJECTIVES : The global targets set out by the Joint United Nations Programme on HIV/AIDS (UNAIDS) for 2020 are to diagnose 90% of all HIV-positive people, provide antiretroviral therapy for 90% of those diagnosed, and achieve viral suppression for 90% of those treated (known as 90-90-90 targets). In Italy, there is no uniform HIV screening strategy across the country. Our study aimed to assess the cost-effectiveness of expanded HIV screening among adult population (25-50 years).

METHODS : A decision tree was combined with a previously published Markov model for evaluate the management of HIV-infected patients in Italy. The model was informed by epidemiological and cost estimates taken from different sources (literature and real-world data). The cohort of new HIV diagnosed patients effectively linked to care in Italy (2,847 patients) was followed over a 30-year time horizon evaluating different scenarios for new HIV diagnoses due to the expanded HIV screening. The analysis was conducted from the National Health Service perspective and both costs and QALYs were discounted at an annual rate of 3%. Deterministic and probabilistic sensitivity analysis were conducted to evaluate parameter uncertainty.

RESULTS : Our preliminary analysis showed that with an increase of 10% of new HIV linked to care patients, HIV screening strategy resulted in an increment of about 2,466 QALYs and in an increment of about € 73.8 million compared to the status quo from the Italian NHS perspective. The ICER was equal to € 29,943/QALY. Probabilistic sensitivity analysis confirmed that the expanded HIV screening would be cost-effective for > 51% of simulations at a minimum willingness-to-pay threshold of € 30,000 per QALY gained.

CONCLUSIONS : In Italy there is an urgent need to apply HIV screening strategies to increase awareness of the risks of the disease. Our analysis indicates that the expanded HIV screening in adult population would be cost-effective.