Analyse coût-efficacité de l’accès précoce aux soins médicaux et sociaux pour les immigrants atteints du VIH en France
(Ecole d’économie de Paris)
17 décembre 2014, 17h00-19h00
Hôtel-Dieu, Amphithéâtre Lapersonne,
1 Parvis Notre-Dame, 75004 Paris
In 2011, migrants accounted for 47% of newly diagnosed cases of HIV infection in France, including 70% from Sub-Saharan Africa. These populations meet with specific obstacles leading to late diagnosis and access to medical and social care. Reducing these delays has a proven benefit to patients’ health and contributes to a better control of the epidemic by preventing secondary infections. The objective of this study is to assess the cost-effectiveness impact of an early access to care (ATC) for migrant people living with HIV (PLHIV) in France. The model compares « early » vs. « late » ATC for migrant PLHIV in France, defined by an entry into care with a CD4 cell count of 350 and 100/mm3 respectively. Total costs and secondary infections are compared. Total costs include lifelong cost of care for patients once they are diagnosed plus costs associated with secondary infections. Early ATC strategy proved cost-saving, or cost-effective in the worst case scenario. These results remained robust even when late ATC was defined as an entry into care with a CD4 count of 200/mm3 and/or facing adverse changes in key model parameters. In the most favorable scenario, early ATC generated an average net saving of €198,000 (~USD 271,000) per patient, and prevented 0.542 secondary infection. In the worst case scenario, early ATC strategy generated an average cost of €28,000 (~USD 38,000), a cost-effectiveness ratio of €19,000 (~USD 26,000)/QALY), which is considered cost-effective in France, and prevented 0.211 secondary infection. In addition to individual health benefit, improving early ATC for migrant PLHIV proves an efficient strategy in terms of public health and economics. These results stress out the benefit of ensuring ATC for all individuals living with HIV in France. Further research should focus on ways to improve access to care for migrants in France.
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