Objective: To analyze the cost-effectiveness and willingness-to-pay of HIV self-testing (HIVST) strategy and facility-based HIV rapid testing (HIV-RDT) strategy in men who have sex with men (MSM) in Zhuhai, and provide scientific evidence for making health policy. Methods: From the perspective of health service providers, the data of the costs and effectiveness of two HIV testing strategies in MSM in Zhuhai during January-September 2019 were collected, and a decision-tree model of cohort of 10 000 MSM was constructed by using software TreeAge Pro 2019 to measure the cost-effectiveness ratio (CER) and the incremental cost-effectiveness ratio (ICER). One-way and probability sensitivity analysis was performed for the uncertainty of the parameters in the model, and the cost-effectiveness and affordability curve was introduced to estimate the affordability of two strategies. Results: After the mobilization of MSM community-based organization through Internet and social media, 2 303 MSM had HIVST, in whom 33 were HIV positive (1.7%), and 816 MSM received HIV-RDT, in whom 35 were HIV positive (4.3%). The cost for per screening was 60.45 yuan and 240.43 yuan (RMB) respectively, and the cost for per positive screening was 4 218 yuan and 5 606 yuan (RMB) rerspectively. The results of the decision-tree model showed that the mean cost for a MSM using HIVST and using HIV-RDT was 44.67 yuan and 148.42 yuan (RMB) respectively, and the ICER was negative. HIVST strategy was a more cost-effective option when the willing-to-pay was below 6 528 yuan (RMB) for per positive screening, and HIV-RDT strategy was a more cost-effective option when the investment was higher than 6 528 yuan (RMB). Conclusion: HIVST strategy in Zhuhai is a public health project with economic value, and policy makers should strengthen the support to MSM community-based organization to promote the application of HIVST among MSM.
目的： 分析珠海市MSM中HIV自我检测（HIVST）模式和现场HIV快速检测（HIV-RDT）模式的成本效果和支付意愿，为政府合理配置卫生资源提供参考依据。 方法： 以卫生服务提供者的视角，收集珠海市在2019年1-9月MSM参与两种HIV检测模式的成本投入和效果产出，采用TreeAge Pro 2019软件构建10 000名MSM队列决策树模型，测算成本效果比（CER）和增量成本效果比（ICER），以敏感性分析模型中各参数的不确定性，绘制成本效果可支付曲线评价策略的可支付性。 结果： 珠海市男同社会组织通过互联网+社交媒体动员参与HIVST和现场HIV-RDT的MSM人次数为2 303 vs. 816，发现HIV筛查阳性者人数为33 vs. 35，筛查阳性率为1.7% vs. 4.3%。每筛查1例的成本为60.45元vs. 240.43元，每发现1例筛查阳性的成本为4 218元vs. 5 606元。决策树模型运行结果显示，每检测1例MSM的平均费用为44.67元vs. 148.42元，ICER为负值。当发现1例HIV筛查阳性支付意愿低于6 528元时，HIVST更具成本效果的选择；当投入高于该阈值时，现场HIV-RDT是更具成本效果的选择。 结论： 珠海市现行的HIVST模式是具有经济学价值的公共卫生项目，决策者应加大社会组织扶持力度，推广HIVST在MSM中的应用。.
Keywords: Community-based organization; Cost-effectiveness analysis; HIV rapid diagnostics testing; HIV self-testing; Men who have sex with men.