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Table 5 Point of Care Testing Regime: Community Peer Testing Service Setting (Funded by State Government)

From: Economic evaluation of alternative testing regimes and settings to detect undiagnosed HIV in Australia

 

True HIV Positive (PHIV)

True HIV Negative (1 − PHIV)

Outcomes

DHC+, EIA+, WB+

DHC-

DHC+, EIA-

DHC+, EIA+, WB-

DHC+ EIA-

DHC-

Probability of result

(PHIV ∗ SenDHC ∗ SenEIA ∗ SenWB )

(PHIV ∗ (1 − SenDHC))

(PHIV ∗ SenDHC ∗ (1 − SenEIA))

((1 − PHIV) ∗ (1 − SpecDHC) ∗ (1 − SpecEIA) + SpecWB )

((1 − PHIV) ∗ (1 − SpecDHC) ∗ SpecEIA )

(1 − PHIV) ∗ SpecDHC

Inputs

 Visit 1: Initial Screening - Community Peer Testing Service

  Consult time

60 Min

30 Min

60 Min

60 Min

60 Min

30 Min

  Staff Wage (Rate/Hour):

$45

$45

$45

$45

$45

$45

  Staffing

Peer

Peer

Peer

Peer

Peer

Peer

 Pathology costs

  Rapid Alere (DHC) Determine Test

$11

$11

$11

$11

$11

$11

Referral to Bulk Billing GP for Confirmatory Testing

 Visit 1: Initial Screening

  Consult time

20 min

 

20 min

20 min

20 min

 

  Medicate Rebate

$71.701

 

$71.701

$71.701

$71.701

 

  Staffing

GP

 

GP

GP

GP

 

 Pathology costs

  EIA test

$15.652

 

$15.652

$15.652

$15.652

 

  WB confirmatory

$29.003

  

$29.003

  

 Visit 2: Test Results

  Consult time

40 min

 

20 min

20 min

20 min

 

  Medicate Rebate

$105.554

 

$71.701

$71.701

$71.701

 

  Staffing

GP

 

GP

GP

GP

 

Total Cost of Each Outcome

$277.90

$33.50

$215.05

$244.05

$215.05

$33.50

Average cost per person tested

=(PHIV ∗ SenDHC ∗ SenEIA ∗ SenWB) ∗ AC per True PositiveDHC + , EIA + , WB+ + (PHIV ∗ (1 − SenDHC)) ∗ AC per False NegativeDHC− + (PHIV ∗ SenDHC ∗ (1 − SenEIA)) ∗ AC per False NegativeDHC + , EIA− + ((1 − PHIV) ∗ SpecDHC) ∗ AC True NegativeDHC− + ((1 − PHIV) ∗ (1 − SpecDHC) ∗ SpecEIA) ∗ False PositiveDHC + , EIA− + ((1 − PHIV) ∗ (1 − SpecDHC) ∗ (1 − SpecEIA) ∗ SpecWB) ∗ False PositiveDHC + , EIA + , WB−

Average number of tests for a positive diagnosis

\( =\frac{1}{P_{HIV}\ast Se{n}_{DHC}\ast Se{n}_{EIA}\ast Se{n}_{WB}} \)

  1. Note: AC Average Cost, DHC Alere Determine™ HIV-1/2 Ag/Ab Combo Test, EIA fourth generation enzyme immunoassay test, GP General Practitioner, P Probability, Sen Sensitivity, Spec Specificity, WB Western Blot Test, + = reactive test result, − = nonreactive test result. 1 = Medicare Rebate Item 36; 2 = Medicare Rebate Item 69,384; 3 = Medicare Rebate Item 69,387; 4 = Medicare Rebate Item 44