Cost-effectiveness of community-based HIV self-testing in Blantyre, Malawi
Maheswaran et al.
Type of approach
Type of assistance
General population: 58% female; mean age 30 years
UNAIDS HIV prevalence (2017)
In this cost-effectiveness model for HIV testing approaches, the costs of three approaches were compared: standard HIV testing using 2010 WHO guidelines on antiretroviral treatment, standard HIV testing using 2015 WHO guidelines on antiretroviral treatment, and standard HIV testing plus HIV self-testing using either 2010 or 2015 WHO guidelines. Costs and health outcomes were evaluated over a 20-year time horizon, using a discount rate of 3%. Probabilistic sensitivity analysis was conducted to account for parameter uncertainty.
Summary of findings
From the health provider perspective and 20-year time horizon, facility HIV testing and counselling using 2010 WHO ART guidelines was the least costly ($294.71 per person) and least effective (11.64 quality-adjusted life-years per person) strategy. Compared with this strategy, the incremental cost-effectiveness ratio for facility HIV testing and counselling using 2015 WHO ART guidelines was $226.85 per quality-adjusted life year gained. The strategy of facility HIV testing and counselling plus HIV self-testing (HIVST), using 2010 WHO ART guidelines, was extendedly dominated. The incremental cost-effectiveness ratio for facility HIV testing and counselling plus HIVST, using 2015 WHO ART guidelines, was $253.90 per quality-adjusted life year gained compared with facility HIV testing and counselling using 2015 WHO ART guidelines.
Willingness to pay
Willingness to pay details
Linkage to prevention, care and treatment