P1-S4.30 Point-of-Care HIV Testing with OraQuick Advance HIV-1/2 antibody assay: a systematic review of cost outcomes

Background Recently Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group called for a shift from diagnostic accuracy to emphasis on patient-centred outcomes for making policy recommendations. While meta-analyses have evaluated diagnostic accuracy of POC HIV tests, a systematic appraisal of other implementation research outcomes, such as cost, is lacking. Within this context, we reviewed global evidence on cost outcomes of OraQuick Advance HIV—1/2 Antibody Test. Method We systematically searched six electronic databases for the period of January 1999 to January 2011. Cost outcomes with OraQuick tests were reviewed and data extracted. For economic evaluation we accepted both partial and full study designs. Outcomes were synthesised into a narrative review. Results We identified nine studies offering economic evaluations of oral and blood based OraQuick, of which six were full economic evaluations and remaining were partial evaluations. The full economic evaluations included five Cost Effectiveness Analysis (CEA) and one Cost Utility Analysis (CUA) design; one partial evaluation was a cost comparison study and two were cost analysis studies. All studies were in the USA except one, which was from Mexico. All studies performed sensitivity analyses to explore the impact of uncertainty in their model parameters and findings. Methodological approaches applied by the authors were not standardised and program cost varied by location, but overall there was uniformity in the study conclusions. The studies concluded that OraQuick was cost effective in low prevalence settings and resulted in low rates of false positives which have favourable economic implications. The tests were found to be cost saving to the medical system, and offer the advantage of convenience in administration when compared to current standards of care. Since it was recognised that pre- and post-test counselling cost and personnel costs accounted for most of the overall costs for these rapid tests, one approach that was proposed to reduce this cost was to limit the time spent on counselling or by using lower-paid personnel for counselling activities. Conclusion The economic evaluation results presented here can guide program managers and health policy decision makers in the research for efficient HIV testing options, for the proper allocation of healthcare resources and for adoption of models of healthcare delivery that represent the best value for money.