Imperial College London


Faculty of MedicineSchool of Public Health

Professor of Global Health



+44 (0)20 7594 1150timothy.hallett




Norfolk PlaceSt Mary's Campus






BibTex format

author = {Phillips, AN and Cambiano, V and Nakagawa, F and Bansi-Matharu, L and Wilson, D and Jani, I and Apollo, T and Sculpher, M and Hallett, T and Kerr, C and van, Oosterhout JJ and Eaton, J and Estill, J and Williams, B and Doi, N and Cowan, F and Keiser, O and Ford, D and Hatzold, K and Barnabas, R and Ayles, H and Meyer-Rath, G and Nelson, L and Johnson, CC and Baggaley, R and Fakoya, A and Jahn, A and Revill, P},
doi = {10.1002/jia2.25325},
journal = {Journal of the International AIDS Society},
pages = {1--10},
title = {Cost-per-diagnosis as a metric for monitoring cost effectiveness of HIV testing programmes in low income settings in southern Africa: health economic and modelling analysis},
url = {},
volume = {22},
year = {2019}

RIS format (EndNote, RefMan)

AB - Introduction: As prevalence of undiagnosed HIV declines, it is unclear whether testing programmes will be cost effective. To guide their HIV testing programmes,countries require appropriatemetrics that can be measured. The cost-per-diagnosisis potentially a useful metric. Methods:We simulated a series of setting-scenarios for adult HIV epidemics and ART programmes typical of settings in southern Africa using an individual-based model and projected forward from 2018 under two policies: (i) a minimum package of “core” testing (i.e. testing in pregnant women, for diagnosis of symptoms, in sex workers, and in men coming forward for circumcision) is conducted, and (ii) “core” testing as above plus “additional-testing”, for which we specify different rates of testing and various degrees to which those with HIV are more likely to test than thosewithout HIV. We also considered a plausible range of unit test costs. The aim was to assess the relationship between cost-per-diagnosisand the incremental cost-effectiveness ratio(ICER) of the additional-testingpolicy. Discount rate 3%; costs in 2018 $US. Results:There was a strong graded relationship between the cost-per-diagnosisand the ICER. Overall, the ICERwas below $500 per-DALY-averted (the cost effectiveness threshold used in primary analysis) so long as thecost-per-diagnosiswas below $315. This thresholdcost-per-diagnosiswas similar according to epidemic and programmatic features including the prevalence of undiagnosed HIV, the HIV incidence and a measure of HIV programme quality (the proportion of HIV diagnosed people having a viral load <1000 copies/mL). However, restrictingto women, additional-testingdid not appear cost-effective even at acost-per-diagnosisof below $50, while restrictingto men additional-testingwas cost effective up to a cost-per-diagnosisof $585. Thethreshold cost for testing in men fell to $256 when the cost effectiveness threshold was $300instead of $5
AU - Phillips,AN
AU - Cambiano,V
AU - Nakagawa,F
AU - Bansi-Matharu,L
AU - Wilson,D
AU - Jani,I
AU - Apollo,T
AU - Sculpher,M
AU - Hallett,T
AU - Kerr,C
AU - van,Oosterhout JJ
AU - Eaton,J
AU - Estill,J
AU - Williams,B
AU - Doi,N
AU - Cowan,F
AU - Keiser,O
AU - Ford,D
AU - Hatzold,K
AU - Barnabas,R
AU - Ayles,H
AU - Meyer-Rath,G
AU - Nelson,L
AU - Johnson,CC
AU - Baggaley,R
AU - Fakoya,A
AU - Jahn,A
AU - Revill,P
DO - 10.1002/jia2.25325
EP - 10
PY - 2019///
SN - 1758-2652
SP - 1
TI - Cost-per-diagnosis as a metric for monitoring cost effectiveness of HIV testing programmes in low income settings in southern Africa: health economic and modelling analysis
T2 - Journal of the International AIDS Society
UR -
UR -
UR -
VL - 22
ER -