BibTex format
@article{Walker:2026:10.1016/S2352-3018(26)00109-8,
author = {Walker, JG and Baggaley, RF and Myring, G and Irvine, MA and Asgharzadeh, A and Laurence, YV and Bell, E and Schoemig, V and Cross, E and Allison, S and Kundu, B and McNaughton, AL and Brown, J and Cresswell, D and van, Halsema C and Hassan-Ibrahim, MO and Roberts, J and Ahmad, S and Todd, R and Heath, R and Ward, Z and Simmons, R and May, T and Hill-Tout, R and Horwood, J and Desai, M and Vickerman, P and Djuretic, T and Hickman, M and Mandal, S},
doi = {10.1016/S2352-3018(26)00109-8},
journal = {Lancet HIV},
title = {Cost-effectiveness of emergency department opt-out testing for HIV in England: a modelling study.},
url = {http://dx.doi.org/10.1016/S2352-3018(26)00109-8},
year = {2026}
}
RIS format (EndNote, RefMan)
TY - JOUR
AB - BACKGROUND: In England, up to 5% of people living with HIV are undiagnosed and the proportion of late diagnoses remains high. Opt-out testing could help to identify people living with undiagnosed HIV who might not access testing in other settings. We aimed to evaluate the cost-effectiveness of the first phase of UK National Health Service (NHS)-funded opt-out testing for HIV in emergency departments, which scaled up from 2022. METHODS: We adapted a previously developed deterministic model of HIV diagnosis, progression, and transmission to simulate the impact of the first 33 months of the opt-out testing intervention in improving HIV diagnosis, incorporating programme data on CD4 cell count at diagnosis. We conducted a bottom-up costing of the intervention in two sites, from an NHS perspective, and gathered costs of HIV care from the literature. In the base case we assumed 93% of new diagnoses would not have been diagnosed elsewhere during the programme as these individuals had never previously been tested for HIV. Cost-effectiveness is presented as incremental costs per quality-adjusted life-year (QALY) gained over 20 years compared with a £25000-35000 per QALY threshold. We explored scenario analyses to address the limitations of the model assumptions. FINDINGS: The mean cost per HIV test was £6·31 (US$7·91). Under base case assumptions, emergency department opt-out testing is projected to avert 187 HIV-related deaths (95% credible interval 182-196) and 28 secondary acquisitions (26-52) over 20 years, costing £18630 (17413-23119) per QALY gained. This result is robust (below £35000 per QALY) to different assumptions about HIV-related quality of life and HIV care costs, HIV-related mortality, and the rate of diagnosis outside the programme. Under a lower test yield scenario of 0·20 new diagnoses per 1000 tests (compared with 0·29 in the base case), the intervention remains cost-effective at £25000 per
AU - Walker,JG
AU - Baggaley,RF
AU - Myring,G
AU - Irvine,MA
AU - Asgharzadeh,A
AU - Laurence,YV
AU - Bell,E
AU - Schoemig,V
AU - Cross,E
AU - Allison,S
AU - Kundu,B
AU - McNaughton,AL
AU - Brown,J
AU - Cresswell,D
AU - van,Halsema C
AU - Hassan-Ibrahim,MO
AU - Roberts,J
AU - Ahmad,S
AU - Todd,R
AU - Heath,R
AU - Ward,Z
AU - Simmons,R
AU - May,T
AU - Hill-Tout,R
AU - Horwood,J
AU - Desai,M
AU - Vickerman,P
AU - Djuretic,T
AU - Hickman,M
AU - Mandal,S
DO - 10.1016/S2352-3018(26)00109-8
PY - 2026///
TI - Cost-effectiveness of emergency department opt-out testing for HIV in England: a modelling study.
T2 - Lancet HIV
UR - http://dx.doi.org/10.1016/S2352-3018(26)00109-8
UR - https://www.ncbi.nlm.nih.gov/pubmed/42349479
ER -