Table 4 Comparison of cost-effectiveness results from a healthcare or payer perspective and societal perspective

Adamson et al.

Financial incentives for HIV viral suppression

Societal, Healthcare

Intervention:

Cost-effective

US$ 49,877/QALY

[US$ in 2021: 53,819]

Intervention:

Cost-saving (dominant)

Threshold used: range from $50,000 to $150,000 per QALY gained

Excluding productivity and non-health care expenditures, financial incentives for viral suppression [intervention] cost US$ 3033 more per patient compared to the standard-of-care cost [comparator] (US$ 487,993 vs. US$ 484,961)

[US$ in 2021: 526,562 vs. 523,290]

The total discounted lifetime societal cost was US$ 4210 lower for

financial incentive patients [intervention] than for the standard-of-care patients [comparator]

(US$ 268,255 vs. US$ 272,464 per patient, respectively)

[US$ in 2021: 289,457 vs. 293,998]

The greatest change among cost categories was the US$ 3685 per patient increase in lifetime ART drug costs for financial incentives compared to standard of care

[US$ in 2021: 3976]

A majority of financial incentive

cost savings were attributable to lifetime productivity gains of

US$ 10,686 per patient.

[US$ in 2021: 11,530]

Excluding non-health care costs and productivity, financial incentives for viral suppression were cost-effective with an ICER of US$ 49,877 per QALY gained compared to the standard of care

[US$ in 2021: 53,819]

Financial incentives for viral suppression gained 0.06 QALYs per patient and avoided US$ 4210 per patient compared to the standard of care (Table 2).

[US$ in 2021: 4543]

Financial incentives “dominated” the standard of care because patients and partners had better health outcomes for a lower cost.

NA

Lifetime productivity gains of US$ 10,686 per patient

[US$ in 2021: 11,530]

Damm et al.

HPV vaccination in addition to screening

Societal, Healthcare

Intervention (2-dose):

Cost-effective

19,450€ per QALY for the bivalent

[US$ in 2021: 27,305]

3645€ per QALY for the quadrivalent vaccine

[US$ in 2021: 5117]

Intervention (2-dose):

Cost-saving

Threshold used: €50,000

Under certain scenarios: A 2-dose approach using the quadrivalent vaccine was a cost-saving strategy while using the bivalent vaccine resulted in an ICER of 13,248€ per QALY

[US$ in 2021: 18,598]

Intervention (3-dose):

ICERs of a 3-dose schedule were 53,807€ per LY and 34,249€ per QALY for the bivalent vaccine

[US$ in 2021: 75,539 and 48,082] and 30,910€ per LY and 14,711€ per QALY for the quadrivalent vaccine

[US$ in 2021: 43,394 and 20,653]

Intervention (3-dose):

Inclusion of indirect costs decreased the ICERs to 28,047€ and 8984€ per QALY for the bivalent and the quadrivalent vaccine, respectively.

[US$ in 2021: 39,375 and 12,613]

Sensitivity analysis: In scenarios with low coverage, the use of the quadrivalent vaccine led to cost savings from a societal perspective

Gift et al.

Expedited partner treatment (EPT) for Chlamydia and Gonorrhoea

Societal, Healthcare, Individual payer

Intervention (individual payer perspective):

Cost-effective (under a wide range of assumptions)

When EPT was not cost saving from the individual payer perspective, the incremental cost per QALY gained through EPT compared with Standard Referral (SR) was less than US$ 13,000 a cost per QALY that is typically considered to be very cost-effective

[US$ in 2021: 16,124]

Intervention (societal or healthcare perspective):

Cost saving

Threshold used: NR

It resulted in more partners treated at lower cost

Mahumud et al.

HPV vaccination

Societal, Health System

Intervention:

Cost-effective

From the health system and societal perspectives, the 9vHPV vaccination was very cost-effective in comparison with the status quo, with an ICER of A$47,008 and A$44,678 per DALY averted, respectively

Intervention:

Cost-effective

Threshold used: heuristic cost-effectiveness threshold as defined by the WHO Commission on Macroeconomics and Health (A$73,267)

From the health system and societal perspectives, the 9vHPV vaccination was very cost-effective in comparison with the status quo, with an ICER of A$47,008 and A$44,678 per DALY averted, respectively

Nosyk et al.

HIV Population-level HAART expansion (testing and treatment)

Societal, Third-party payer (TPP)

Intervention:

Cost-effective

From a TPP perspective, ‘observed HAART access’ cost CAN$ 23,679 per QALY gained, compared to the ‘75% observed access’ scenario, and CAN$ 24,250 per QALY gained compared to the ‘50% observed access’ scenario, making observed HAART scale-up highly cost-effective [US$ in 2021: 22,625 and 23,171]

Intervention:

Cost-saving

Threshold used: WHO thresholds for cost-effectiveness

Observed HAART access resulted in savings of CAN$ 25.1 M and CAN$ 66.5 M in present value compared to 75 and 50% HAART access scenarios, respectively

[US$ in 2021: 23,955,214 and 63,467,001]

Productivity gains due to HAART access more than offset the additional costs of treatment, resulting in ‘Observed HAART access’ being a dominant strategy (lower total costs, higher QALY gains)

Wolff et al.

Sex-neutral HPV vaccination

Societal, Healthcare

Intervention:

Likely to be cost-effective

ICER was higher from a healthcare perspective, which did not include gains from decreased production losses: 40,821€ [US$ in 2021: 50,461]

Intervention:

Likely to be cost-effective

Threshold used: €50,000

ICER was lower from a societal perspective, which considered cost of production loss: 38,237€

[US$ in 2021: 47,265]

Zechmeister et al.

HPV vaccination in addition to screening

Societal, Public payer

Intervention:

Not cost-effective

Applying a shorter time frame and a payer’s perspective or vaccinating boys may not be cost-effective without reducing the vaccine price

Intervention:

Cost-effective

Threshold used: NR

HPV-vaccination for girls should be cost-effective when adopting a longer time-horizon and a societal perspective

Discounted ICER for HPV-vaccination of girls only was 64,000€ per LYG

[US$ in 2021: 79,111]

Discounted ICER for HPV-vaccination of girls only was 50,000€ per LYG (lower compared to a healthcare perspective) [US$ in 2021: 61,800]

For vaccinating girls and boys compared to girls only, the corresponding ICERs were 311,000€ per LYG

[US$ in 2021: 384,399]

For vaccinating girls and boys compared to girls only, the corresponding ICERs were 299,000€ per LYG (lower compared to a healthcare perspective) [US$ in 2021: 369,564]

Zulliger et al.

HIV testing and linkage to care among men having sex with men (MSM)

Societal, Payer

NA

[Results for payer and societal perspective were not reported separately]

Intervention (venue-based testing program in all cities):

Cost-saving

Threshold used: $100,000 (The cost-saving threshold for HIV testing was $20,645 per new HIV diagnosis)

Cost-utility analysis of the MSM Testing Initiative (MTI) programs demonstrated that all venue-based testing programs were cost-saving

Intervention (voluntary counselling and testing strategies, social network strategies):

Partially not cost-effective, depending on the city