Claude Universite

Bernard -Lyon

M Le Professeur

Frédéric Fleury

Hamda Ben

Hadid M Le Professeur Didier

Revel M Le Professeur

Philippe Chevalier

M Fabrice

Vallée Mme

Dominique Marchand

Composantes Sante

G Rode

La Mme

C Professeure

Burillon

D Bourgeois

Vinciguerra

M X Perrot

A-M Professeure

Schott

Professor Katarzyna Kolasa

Keywords: HIV, testing, costs, savings, model, late detection, early presentation

Purpose: To estimate the potential budget savings and survival impact from achieving an increase in the proportion of HIV cases that are detected early in a given UK or Poland population, thus translating it into a budget for implementing interventions relating to an increase in the uptake of HIV.

Patients and methods:

A Microsoft Excel decision model (Sunrise) was designed to generate a set of outcomes for a defined population. Survival was modeled on the COHERE study extrapolated to a 5-year horizon as a constant hazard. Hazard rates were specific to age, sex and whether detection was early or late. The primary outcomes for each year up to 5 years were: annual costs, numbers of infected cases, hospital admissions and surviving cases.

Secondary outcomes included estimating needed cost of a HIV test and prevalence rate for reinvestment of potential cost savings to achieve budget neutrality. Total population was observed in UK and Poland. ISPOR Budget Impact Model -Principles of Good Practice were utilized in Sunrise development.

Results:

The projected cumulative cost-savings over 5 years in Poland and UK were 5,823,479 PLN (£1,109,234) and £21,608,562 respectfully. When including the value of lifeyears saved projected cumulative cost-savings in Poland and UK amounted to 8,374,018 PLN (£1,595,051) and £29,834,679 respectively. Savings were insensitive to transmission rates, but were sensitive in direct proportion to the percentage shift from late to early detection. In UK, savings were in higher proportion to Poland, due to much higher overall cost of HIV treatment (whether early or late HIV detected patient). 9 Conclusion: Estimated cost savings that could be translated into identification of appropriate programs (providing wider coverage of HIV testing, awareness building) that would lead towards higher proportion of early HIV detected patients are very sensitive to the cost of HIV test, HIV prevalence, incidence and overall HIV treatment cost.

COMPOSANTES ET DEPARTEMENTS DE SCIENCES ET TECHNOLOGIE

Every year millions of people worldwide still die of AIDS. Today's HIV treatments are not a cure. Rather, current therapies can only suppress the virus and slow the progression of HIV disease. While current anti-HIV drugs ("anti-retroviral") have saved millions of people from an early death, no existing HIV treatment eradicates the virus from the body. For every two people who access HIV treatment, another five become infected worldwide. . By mid-2015, 15.8 million people living with HIV were receiving antiretroviral therapy (ART) globally [START_REF] Who | HIV/AIDS Fact sheet # 360[END_REF]. The unmet known outcome of early detection is that researchers predict that a young adult today who begins treatment shortly after diagnosis, who has minimal co-existing health conditions and who takes treatment every day exactly as directed should have a near-normal life expectancy. However, it is dependent on HIV testing at a very early stage of HIV disease.

Late diagnosis of HIV remains a serious problem across

Policy makers may not be aware of the actual burden of HIV and potential savings of switching patients from late to early detection and at the same time how much to invest to experience budget neutrality. This study attempts to find these answers.

This study established burden of illness perspective of early vs. late HIV detection in the UK and Poland. Thus, the impact of the early vs. late HIV detection was measured in terms of economic, clinical and humanistic burden.

Research was conducted using three stages:

1) Started with systematic literature review to account for and identify burden of HIV relating to early vs. late HIV detection. A systematic literature review was conducted using MEDLINE, EMBASE and CRD for established methodology, guidelines and clinical trials published 2008-2016 in EU-26, Non-EU central European countries, USA and Canada.

2) Decision modeling was utilized for each region of UK and Poland. Burden of Illness decision model was developed using ISPOR principles of good practice for budget impact analysis guidelines.

3) "Sunrise" model was integrated in the report by HIV Scotland and presented to UK Parliament House of Lords, Select Committee on HIV and AIDS in the UK [START_REF] House | Select Committee on HIV and AIDS in the United Kingdom, HIV and AIDS in the United Kingdom -Written Evidence A to Z, Memorandum by HIV Scotland[END_REF].

In 2008, it was estimated that 30,000 people in Poland were infected with HIV (human immunodeficiency virus), with approximately 30.5% unaware of their condition. [START_REF] Fronczak | Declaration of Commitment on HIV/AIDS, General Assembly[END_REF] In 2014, as many as 1,085 people were newly infected in Poland. [START_REF]Annual report infectious diseases and poisonings in Poland[END_REF] The estimated prevalence of HIV in Poland and UK (United Kingdom) was 0.8 and 1.5 per 1000 population (all age), with a greater proportion of infected males (1.3 and 3.7 per 1000) than females (0.3 and 1.9 per 1000) respectively [START_REF] Yin | HIV in the United Kingdom 2014 Report: data to end 2013[END_REF][START_REF] Niedźwiedzka-Stadnik | HIV and AIDS in Poland in 2013[END_REF]. In 2013, it was estimated that 107,800 people in the United Kingdom (UK) were infected with HIV, with unchanged number of approximately 24% unaware of their condition [START_REF] Yin | HIV in the United Kingdom 2014 Report: data to end 2013[END_REF].

A late diagnosis of HIV is the most important predictor of morbidity and short-term mortality in HIV infected individuals. A late HIV diagnosis is defined as a CD4 count ˂350 cells//µl within three months of an HIV diagnosis [START_REF]Annual report infectious diseases and poisonings in Poland[END_REF]. It has been estimated that the difference in predicted life expectancy between early diagnosis (CD4 count 432 cells/µl) and late diagnosis (CD4 count 140 cells/µl) is 3.5 years [START_REF] Nakagawa | Projected life expectancy of people with HIV according to timing of diagnosis[END_REF]. Other studies have confirmed that early detection and high CD4 counts can result in life expectancies similar to those of the general population [START_REF] Mocroft | Risk Factors and Outcomes for Late Presentation for HIV-Positive Persons in Europe: Results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE)[END_REF][START_REF] Van Sighem | Life expectancy of recently diagnosed asymptomatic HIV-infected patients approaches that of uninfected individuals[END_REF]. A direct benefit of early detection is that infected individuals can immediately start antiretroviral treatment (ART) if they meet the treatment initiation criterion, which in Poland is a CD4 cell count below 500 cells/µl and UK for primary infection was a CD4 cell count below 350 cells/µl and in case of co-infection over 500 cells/µl [START_REF] British Hiv Association | BHIVA guidelines for the treatment of HIV-1 positive adults with antiretroviral therapy 2012[END_REF][START_REF] Horban | Terms of care over persons infected with HIV: Recommendations PTN AIDS[END_REF]. Individuals diagnosed late with HIV are six times more likely to die of AIDS than those diagnosed earlier [START_REF]British HIV Association[END_REF]. Not only does early detection increase life expectancy, it also decreases the annual cost of healthcare [START_REF] Beck | Cost-effectiveness of early treatment with first-line NNRTI-based HAART regimens in the UK, 1996-2006[END_REF][START_REF] Beck | The cost-effectiveness of early access to HIV services and starting cART in the UK, 1996-2008[END_REF][START_REF] Krentz | The high cost of medical care for patients who present late (CD4<200 cells/µL) with HIV infection[END_REF].

There has been an overall trend in the UK towards earlier detection; in 2004 it was estimated that 57% of individuals were diagnosed late within three months of their diagnosis (CD4 cell count < 350 cells/µl), which had improved to only 42% by 2013 [START_REF] Yin | HIV in the United Kingdom 2014 Report: data to end 2013[END_REF].

Both Polish and UK national guidelines on HIV testing reflect the need for earlier detection and intervention [START_REF] Horban | Terms of care over persons infected with HIV: Recommendations PTN AIDS[END_REF][START_REF]UK national guidelines for HIV testing 2008[END_REF]. Universal screening is recommended in genitourinary and sexual health clinics, antenatal services, termination of pregnancy services, drug dependency programs and healthcare services for individuals diagnosed with tuberculosis, hepatitis B and C and lymphoma. In addition, the Polskie Towarzystwo Naukowe (PTN) and British HIV Association (BHIVA) guidelines state that where the HIV prevalence in the local population exceeds 2 per 1000 there should be screening for all persons registering in general practice and all general medical admissions, and that the test should be offered to all high risk groups [START_REF] Horban | Terms of care over persons infected with HIV: Recommendations PTN AIDS[END_REF][START_REF]UK national guidelines for HIV testing 2008[END_REF].

Much of the evidence for the cost-effectiveness of screening comes from modeling studies in the United States (US), where the incremental cost-effectiveness ratio (ICER) for routine HIV testing in an inpatient setting was estimated at $38,600 per Quality-adjusted Life Year (QALY) gained, whilst testing every five years for high-risk patients in the outpatient setting cost $50,000-$57,000 per QALY gained [START_REF] Walensky | Cost-effectiveness of HIV testing and treatment in the United States[END_REF][START_REF] Sanders | Cost-effectiveness of HIV screening in patients older than 55 years of age[END_REF]. When other variables remained constant, estimated ICERs fell (i.e. became more favorable) as the prevalence of HIV infection increased. This provides an economic rationale for expanding universal screening programs to all geographic areas where the prevalence exceeds a given threshold.

The economics of screening become even more favorable when indirect effects are taken into account [START_REF] Walensky | Cost-effectiveness of HIV testing and treatment in the United States[END_REF]. Early detection of HIV-positive status may reduce the rate of onward viral transmission, reducing the numbers of infected individuals and the consequent cost burden within the population at risk. This decision model (Sunrise) predicts the impact of detecting more patients with early HIV presentation rather then late, on healthcare system costs and population survival over a 5-year time period. It illustrates these outcomes at the country and regional level for Poland and UK.

General overview

Polish Ministry of Health is responsible for every citizen disease treatment. National Healthcare Fund (NFZ) is contributed to by each working individual, which in return funds the healthcare system. Every polish citizen has the right to equal access to public healthcare services.

In addition to national healthcare insurance, roughly 65% of the population is privately insured, of which 70% is paid by companies for the employees. Private insurance provides coverage for over and above what national healthcare fund pays, e.g. branded medicines not reimbursed by the NFZ, private setting birth).

Poland has 16 provinces (Voivodeships). Role of each province is to coordinate healhcare services, thus each province has one NFZ branch. Financial allocations among NFZ branches are based on algorithms defined annually by the government and depend on the number, age and gender of the insured regional population. The branches independently contract health services for the insured and divide their budgets between various types of service.

The following diagram depicts the responsibilities of healthcare providers:

Polish system modality of operation regarding HIV patient

There are 29 HIV counseling sites within Poland, predominantly located in cities and bigger towns, e.g. 4 in Warsawa, 2 in Krakow, 2 in Wraclaw and 21 in other towns.

Testing based on Private initiative (i.e. individual seeks to have an HIV test)

Individuals suspecting an HIV infection (for example after unprotected sexual intercourse) can access HIV blood testing only at the specialist HIV clinic. When HIV testing, whether HIV positive or negative results, Individual social identifier is permanently submitted to the provincial database of HIV tested individuals. In addition to, each case of positive HIV has to be directly reported to provincial sanitary inspectorate.

General practitioners are recommended to identify higher risk sexual behavior and/or HIV symptoms, and refer a patient to HIV specialist for testing.

Individuals testing HIV positive for the first time

Individuals who are testing HIV positive for the first time are seen by a specialist (HIV clinician) within 48 hours, and certainly within two weeks of receiving the result, according to the Polish HIV Society 2016 guidelines, enforced by Ministry of Health. Once patients have been detected as HIV positive, starting ART is recommended at any CD4 cell count, including over 500 cells/mm3, according to the same guideline. Previous 2014 Polish HIV Society guideline, recommended starting ART at 350 cells/mm3.

Inpatient stay

Care for HIV-positive people presenting with complications, can only be provided by an HIV specialist. People living with HIV that require specialized ambulatory care do not require referral from a primary care physician or HIV specialist.

HIV Prevention

On average in 2016, Poland spent 2% of GDP on all prevention programmes. There is no published data to account for specific HIV prevention budget. In addition to nationally financed HIV prevention projects, there were other European (EU) Community sponsored projects, in collaboration with local Non-Governmental Organizations (NGO), between EU countries, which in Poland were estimated at 0.31 zloty (0.06 eur) per capita.

General overview

Similar to Polish setting, National Healthcare Services (NHS) cares for every UK citizen free of charge. Private health insurance provides additional coverage, e.g. more expensive medications not found on NHS reimbursement list, private provider procedure where DRG amount exceeds the cap. Prior to 2012, the HIV prevention and treatment services were overseen by NHS local commissioners. Since the health reforms took place in 2012, the provision of HIV services has a fragmented nature:

Local authorities are responsible for testing and prevention, for social support, and for diagnosing and treating sexually transmitted infections NHS England is responsible for HIV treatment.

Clinical commissioning groups (CCGs) are responsible for the health of its entire population and are evaluated by the extent to which they improve outcomes. CCG is also responsible for testing and diagnosis within other treatment episodes (for example in maternity care) and for treatment of most co-morbidities (such as hepatitis). CCGs and NHS England share responsibilities for services in primary care.

CCG is led by an elected board of general practitioners, other clinicians, including a nurse and a secondary care consultant, and lay members. CCG is responsible for roughly 2/3 of the total NHS England budget; Or £ 73.6 billion in 2017/18 and accounts for delivery of health care services, such as mental health services, urgent and urgent care, optional hospital services and community care.

They are individually responsible for population health ranging from less than 100,000 to 900,000 population, although the average population covered by a CCG is about a quarter of a million people.

The following diagram depicts where the commissioning responsibilities lie (adapted from Palmer et al, NHS England, Brighton 2015 presentation). CCGs are GP-led bodies that replaced the Primary Care Trusts (PCTs) the bodies previously responsible for commissioning most services. CCGs are responsible for planning and purchasing the majority of NHS service (secondary care) in their local area. Secondary care is the care usually received in hospital setting.

HIV Commissioning bodies UK CCG modality of operation regarding HIV patient

CCGs Local authorities NHS England

HIV testing in CCGcommissioned services including A&E (emergency department) and other hospital departments or part of abortion services

Non-sexual aspects of psychosexual health services

The role of the CCGs in the treatment pathway for HIV patients relates mainly to three aspects: commissioning testing within a hospital setting, commission hospital admissions and providing counselling for non-sexual aspects. CCGs do no cover the costs for HIV treatments, which fall within the NHS England remit (i.e. antiretroviral treatment ART, including drugs for preexposure prophylaxis ( PrEP)) -please see the diagram above.

Testing based on Private initiative (i.e. individual seeks to have an HIV test)

Individuals suspecting an HIV infection (for example after unprotected sexual intercourse) can access HIV blood testing through a number of entry points: sexual health and reproductive health services, GUM (genitourinary medicine) clinics, GP practices, antenatal clinics and also through local HIV voluntary organisations or substance misuse services. Individual social identifier is not submitted to the national database of tested HIV individual.

Another type of testing, "Point of care" test, is based on saliva sampling or a small spot of blood from one's finger is provided in a clinical setting. The results are available within minutes.

However, there is a concern surrounding false positive and negative HIV results, as they impact patient wellbeing.

Routinely offered HIV testing

Based on the 2008 HIV testing national guidelines set by the National Institute for Health and Care Excellence (NICE), universal HIV testing is recommended in all of the following settings: GUM or sexual health clinics, antenatal services, termination of pregnancy services, drug dependency programmes, healthcare services for those diagnosed with tuberculosis, hepatitis B, hepatitis C and lymphoma. Effectively, in these settings, an HIV testing is routinely offered even if the individual does not initiate the request for one. Also, an HIV testing is recommended in settings where diagnosed HIV prevalence in the local population exceeds 2 in 1000 population for all men and women registering in general practice and for all general medical admissions. HIV testing is also routinely offered to special groups of population (for example, if someone has been diagnosed with a STD, have partners with HIV and so on).

HIV testing may be recommended by other clinicians where patients have symptoms of HIV.

The 2008 NICE HIV testing national guidelines include a long list of clinical indicator diseases for adult HIV infection covering respiratory, neurology, dermatology, gastroenterology, oncology and other disease areas, which might have AIDS-defining conditions.

Individuals testing HIV positive for the first time

Individuals who are testing HIV positive for the first time are seen by a specialist (HIV clinician, specialist nurse or sexual health advisor or voluntary sector counsellor) within 48 hours, and certainly within two weeks of receiving the result, according to 2008 NICE HIV testing guidelines. Once patients have been detected as HIV positive, starting ART is recommended at any CD4, including over 500 cells/mm3, according to BHIVA (British HIV Association) HIV 2015 guidelines (with interim 2016 update). Previous, 2012 BHIVA HIV guideline recommended starting ART at 350 cells/mm3. £ If treatment for another infection is needed, but patient is not yet on ART, then ART should also be started within two weeks. For people starting ART, the guidelines recommend using Tenofovir plus emtricitabine (FTC) in a combination drug (Truvada) plus one of the following six options: dolutegravir, elvitegravir boosted with cobicistat, darunavir boosted with ritonavir, raltegravir, rilpivirine, atazanavir boosted with ritonavir. The drugs can be changed based on the side effects, on HIV becoming resistant to one or more drugs and based on the viral loads being not as good as they could be. Guidelines do not recommend stopping ART because of viral load rebounds.

Inpatient stay

The British HIV Association recommends that care for HIV-positive people presenting with complications of HIV infection, should be provided by an HIV specialist-led multidisciplinary team, frequently in collaboration with other medical specialties. If people living with HIV are hospitalised with a suspected or proven AIDS-defining opportunistic infection/cancer and/or with severe immunosuppression, their care is supervised by or discussed with a clinician experienced in the inpatient management of HIV disease. The access to HIV specialist inpatient unit should take place within 24 hours of referral.

HIV Prevention

In 2016, an average spent on HIV prevention programme was 0.44 per capita. This was a significant drop from 0.80 per capita in the previous year. Higher expenditure was in regions with higher HIV prevalence rate of minimum 2 in 1,000 population. Ratio between higher and lower prevalence rate regions varied between 2-4 times.

Study search keywords selection was an iterative process. There has been a number of studies performed relating to the parts of this study research question, that had similar keyword terms and that this study systematic review had to account for. Namely, term HIV detection varied from study to study; in some studies HIV detection was referred to as a presentation, in others as a diagnosis. UK studies predominantly used term detection. The definition of early detection also varied between studies. In some cases, it was referred to as CD4≥350 cells/μl within three months, in some cases within six months and in some cases as viral load at the time of the first reading (no time frame specificity). CD4 cell count itself as an indicator of early HIV detection migrated from ≥200 cells/μl to ≥350 cells/μl in 2011 [START_REF] Antinori | Late presentation of HIV infection: a consensus definition[END_REF], whereas in there is currently an uptake on European consensus recommendation level to ≥500 cells/μl level.

At the time of the study, consensus definition of early detection as CD4 ≥350 cells/μl within three months from diagnosis, that was accepted in UK and Poland [START_REF] Antinori | Late presentation of HIV infection: a consensus definition[END_REF]. Late detection represented CD4 <350 cells/μl within three months from diagnosis.

In order to capture all relevant papers that may have relevancy to the research question, keywords early or late were included in search. Further, keywords testing or mortality or survival or life or expectancy or life expectancy were also added to the search, as different keyword search strategies were performed in order to identify and augment all findings that may be deemed relevant to the research question. Specific countries were listed in the keyword search, as well as the 2008-2016 year range.

As this is a countries level HIV Population study, it included all patients of all ages. Only studies published in English language were considered.

A preliminary literature review was conducted using MEDLINE, Cochrane Library, EMBASE and CRD for guidelines, reports and clinical trials published 1995-2008 in UK, England, Scotland, Wales, Northern Ireland, USA, Canada, Australia, Norway and EU-26. This preliminary literature review identified 126 publications related to late detection, from which 6 were deemed relevant, but all 6 were updated in the later years.

Then, a systematic literature review was conducted by searching MEDLINE, EMBASE and CRD electronic databases published in English language to identify relevant publications from 2008 to 2016. The gray literature was searched using Google Scholar and key sources such as the World Health Organization (WHO) website. The literature searches were based on the combined searches of the following terms: Initial PubMed search provided 4,085 records per query as follows:

HIV AND ("early" OR "late") AND ("testing" OR "mortality" OR "survival" OR "life" OR "expectancy" OR "life expectancy" OR "detection" OR "diagnosis" OR "presentation") AND ("UK" OR "great britain" OR ("great" AND "britain") OR ("united" AND "kingdom") OR "united kingdom" OR "france" OR "germany" OR "denmark" OR "sweden" OR "norway" OR "finland" OR "poland" OR "czech republic" OR "Czech" OR ("czech" AND "republic") OR "slovakia" OR "italy" OR "spain" OR "portugal" OR "slovenia" OR "hungary" OR "roumania" OR "greece" OR "serbia" OR "montenegro" OR "albania" OR "moldavia" OR "lithuania" OR "latvia" OR "estonia" OR "netherlands" OR "Belgium" OR "luxembourg" OR "liechtenstein" OR "switzerland" OR "iceland" OR "macedonia" OR "FYROM" OR "USA" OR "united states" OR "canada") AND 3) CRD search provided 8 records per query as follows: "HIV" and ("presentation" or "detection" or "diagnosis") After matching search records and removing duplicates between PubMed and Embase there was total of 4,431 unique papers for review. Doing additional search, 24 more studies were identified. During review process, 4,305 papers were deemed as unrelated to the research question. Thus, 102 full-length papers were reviewed. 70 papers were deemed for exclusion (38 due to review or comment, 30 due to limited scope to specific population and 2 due to methodological considerations), leaving total of 32 papers included in this review(see figure I for details).

Systematic literature review successfully revealed study design key parameters necessary for preparing a solution to the research question. These parameters are in detail discussed within 'the model framework' section. In addition to, systematic literature review did not identify any study that already attempted to respond directly to the research question.

With medication innovation such as combination antiretroviral therapy (cART), since 1996, there has been a major improvement in life expectancy of HIV patients, delay and avoidance of AIDS onset due to diligent management of patient HIV viral load [START_REF] Who | HIV/AIDS Fact sheet # 360[END_REF][START_REF] Suligoi | Risk factors for early mortality after AIDS in the cART era: A population-based cohort study in Italy[END_REF][START_REF] Bhaskaran | Changes in the risk of death after HIV seroconversion compared with mortality in the general population[END_REF]. This prompted further research into relationship between mortality and different CD4 viral load levels. [START_REF] Lewden | All-cause mortality in treated HIV-infected adults with CD4 ≥500/mm 3 compared with the general population: evidence from a large European observational cohort collaboration[END_REF][START_REF] Mocroft | Risk Factors and Outcomes for Late Presentation for HIV-Positive Persons in Europe: Results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE)[END_REF]. Elevated risks of early mortality in HIV patients were associated to older age (over 50 years old), female gender, migrant from sub-Saharan Africa and probable HIV exposure categories of injecting drug use (IDU), man having sex with man (MSM) and heterosexual contact [START_REF] Lewden | All-cause mortality in treated HIV-infected adults with CD4 ≥500/mm 3 compared with the general population: evidence from a large European observational cohort collaboration[END_REF][START_REF] Mocroft | Risk Factors and Outcomes for Late Presentation for HIV-Positive Persons in Europe: Results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE)[END_REF][START_REF]UK national guidelines for HIV testing 2008[END_REF][START_REF] Smith | HIV transmission and high rates of late diagnoses among adults aged 50 years and over[END_REF][START_REF] Schackman | Comparison of Health State Utilities Using Community and Patient Preference Weights Derived from a Survey of Patients with HIV/AIDS[END_REF][START_REF] Beck | The cost-effectiveness of early access to HIV services and starting cART in the UK 1996-2008[END_REF][START_REF] Suligoi | Risk factors for early mortality after AIDS in the cART era: A population-based cohort study in Italy[END_REF][START_REF] Yombi | Late presentation for human immunodeficiency virus HIV diagnosis results of a Belgian single centre[END_REF]. However, some studies reported only local nationals, where the foreign nationals exclusion provided solid, but not complete results [START_REF] Suligoi | Risk factors for early mortality after AIDS in the cART era: A population-based cohort study in Italy[END_REF].

As older adults are the least likely of all age groups to practice safe sex and with late-life changes in the reproductive tract and immune system enhancing HIV acquisition susceptibility and physician being less likely to offer to them HIV testing, it makes adults >50 years of age carrying the highest risk of contracting HIV [START_REF] Walensky | Cost-effectiveness of HIV testing and treatment in the United States[END_REF][START_REF] High | HIV and aging: state of knowledge and areas of critical need for research. A report to the NIH Office of AIDS Research by the HIV and Aging Working Group[END_REF]. The CD4 count (HIV viral load) is the most important laboratory indicator of immune function in HIV-infected patients. It is also the strongest predictor of subsequent disease progression and survival according to findings from clinical trials and cohort studies [START_REF] Mellors | Plasma viral load and CD4+ lymphocytes as prognostic markers of HIV-1 infection[END_REF][START_REF] Egger | Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies[END_REF]. It should be measured in all patients at entry into care. Consensus definition of the viral load itself as an indicator of early HIV detection has a major impact on the research question. Namely, different levels of CD4 (<200 cells/μl, <350 cells/μl or <500 cells/μl) impact both early / late population distribution, population survival rates, as well as different levels of early / late detected HIV patient healthcare resource use. The author agrees with other researchers that have also identified that as the definition of early presentation or early HIV detection changes with CD4 cell count threshold moving upward, the distribution of patients also shift more towards late presentation patients. This can create further confusion of over-reported raising late presentation in HIV population over a longer time period, which is certainly not the case [START_REF] Sasse | Late presentation to HIV testing is overestimated when based on the consensus definition[END_REF].

At the time of the study, cART initiation was recommended in patients when CD4 count drops below 350 cells/μl, however revised guidelines published by BHIVA in September 2015, recommend all patients no matter what CD4 cell count, are to be offered cART [START_REF]Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents[END_REF]. Implication of this new guideline is that all patients in the first year would receive cART, whereas it has been previously identified that patients with CD4 cell count ≥350 cells/μl would receive cART starting at year two upon diagnosis, whereas other patients would receive it in the first year of diagnosis [START_REF] Beck | The cost-effectiveness of early access to HIV services and starting cART in the UK, 1996-2008[END_REF]. Because of diversity of cART interventions, the high heterogeneity of the data rendered a meta-analysis inappropriate; thus, a focus was on overall cost of cART treatment per early or late detected patient [START_REF] Beck | The cost-effectiveness of early access to HIV services and starting cART in the UK, 1996-2008[END_REF][START_REF] Tse | A narrative review of cost-effectiveness analysis of people living with HIV treated with HAART: from interventions to outcomes[END_REF].

Literature review revealed differences in mortality risk and survival rates between HIV patients and general population [START_REF] Lewden | All-cause mortality in treated HIV-infected adults with CD4 ≥500/mm 3 compared with the general population: evidence from a large European observational cohort collaboration[END_REF][START_REF] Mocroft | Risk Factors and Outcomes for Late Presentation for HIV-Positive Persons in Europe: Results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE)[END_REF][START_REF] Margaret | Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) Study[END_REF][START_REF]The UK Collaborative HIV Cohort Study (UK CHIC), the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE). Mortality of treated HIV-1 positive individuals according to viral subtype in Europe and Canada: collaborative cohort analysis[END_REF][START_REF] Murray | Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013[END_REF][START_REF] Wolbers | Pretreatment CD4 cell slope and progression to AIDS or death in HIV-infected patients initiating antiretroviral therapy-the CASCADE collaboration: a collaboration of 23 cohort studies[END_REF][START_REF] Nakagawa | Life expectancy living with HIV: recent estimates and future implications[END_REF]. In particular, mortality risk and survival rates varied among early or late detected patients, whether they are male or female, younger or older than 50 years of age, as well as by HIV-1 viral subtype variations. HIV-1 viral subtype variations could not be considered in this study, as there was no HIV national population sample breakdown by HIV-1 viral subtype [START_REF]The UK Collaborative HIV Cohort Study (UK CHIC), the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE). Mortality of treated HIV-1 positive individuals according to viral subtype in Europe and Canada: collaborative cohort analysis[END_REF]. HIV-1 B subtype was most prominent [START_REF] Beck | The cost-effectiveness of early access to HIV services and starting cART in the UK, 1996-2008[END_REF]419 from total 20,784 patients) of all HIV-1 subtypes with crude mortality rate of 12.3 per 1,000 patient years [START_REF]The UK Collaborative HIV Cohort Study (UK CHIC), the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE). Mortality of treated HIV-1 positive individuals according to viral subtype in Europe and Canada: collaborative cohort analysis[END_REF]. Life expectancy in HIV infected population has increased from 1996 through 2008, however it is still about 7-13 years less than that of UK population, which is similar to Poland [START_REF] Lewden | All-cause mortality in treated HIV-infected adults with CD4 ≥500/mm 3 compared with the general population: evidence from a large European observational cohort collaboration[END_REF][START_REF] Margaret | Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) Study[END_REF][START_REF]The UK Collaborative HIV Cohort Study (UK CHIC), the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE). Mortality of treated HIV-1 positive individuals according to viral subtype in Europe and Canada: collaborative cohort analysis[END_REF][START_REF] Rodger | Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPRIT trials compared with the general population[END_REF][START_REF] Nakagawa | Projected life expectancy of people with HIV according to timing of diagnosis[END_REF], see table 4. This life expectancy variations, has been proven to be directly related to CD4 cell count.

Quality assessment was guided by Effective Public Health Practice Project (EPHPP) criteria.

Author rated each of the quality components in terms of selection bias, study design, confounders, blinding, data collection methods, withdrawals/dropouts and integrity of intervention. Reviewer rated each component as strong, moderate, or weak.

Sunrise is a Microsoft Windows-compatible computer program with a user-friendly, graphical interface. It was designed to estimate the potential budget savings and survival impact from achieving an increase in the proportion of HIV cases that are detected early in a given population, thus translating it into a budget for implementing interventions relating to an increase in the uptake of HIV.

Sunrise observes a time period of five years, as this is the most relevant time period that decision makers and policy makers would consider. Although the impact of HIV transmission is greater with an increase in time period observed, five years term was the limiting factor per input from decision makers (HIV Scotland).

Population considered in the model represents newly detected patients from the first year of observation, with inclusion of forecasted newly detected patients in the second through the fifth year.

User input requirements include: population size split by age (< 50 years, ≥ 50 years), sex, the incidence of newly-detected HIV cases per annum and the proportion of early-and latediagnosed patients receiving ART. Other input parameters are set at default values, though they may be altered by users to allow for sensitivity analyses. These parameters include epidemiological assumptions to model survival and transmission; and the annual costs of HIV care contingent on disease status.

Sunrise generates a set of outcomes for the defined population under the current and future scenarios. The primary outcomes are annual costs, numbers of newly HIV infected cases, hospital admissions and surviving cases, for each year to a maximum 5-year horizon. From these primary data, differential outcomes between scenarios are calculated: cost savings, infected cases avoided deaths avoided and life years gained.

Optionally, the model also allows users to input additional costs to support a fuller Polish NFZ and UK NHS (National Health Service) payer perspective. This feature may be used to include assumptions about the costs of interventions that are expected to bring about the user-defined shift in late to early diagnosis. These investment costs are deducted from the savings in the overall cost impact calculation. The calculation of cost impact can optionally include a monetary valuation of survival; for example, £20,000 per life-year gained in UK and £7,000 in Poland [START_REF] Woods | Country-level cost-effectiveness thresholds: initial estimates and the need for further research[END_REF]. By monetizing the flows of survival for each scenario, the net present value (NPV) of the intervention can be calculated; where NPV > 0, the decision rule would be to implement the intervention. The model does not explicitly allow for utility adjustment of survival.

Alternatively, omitting a valuation of survival corresponds to a budget impact analysis. All flows of costs and survival are discounted to present values at 3.5% per annum [START_REF]Discounting of health benefits in special circumstances[END_REF][START_REF] Hm Treasury | The Green Book. Appraisal and evaluation in central government[END_REF][START_REF]NFZNFZ Poland, Rights of the child -patient financing benefits for children -patients[END_REF].

In 2013, percentage of 50+ age group of newly-detected patients was 7.7% and 16.3% in Poland and UK respectively.

Survival was modeled based upon the COHERE study [START_REF] Lewden | All-cause mortality in treated HIV-infected adults with CD4 ≥500/mm 3 compared with the general population: evidence from a large European observational cohort collaboration[END_REF][START_REF] Mocroft | Risk Factors and Outcomes for Late Presentation for HIV-Positive Persons in Europe: Results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE)[END_REF][START_REF]The UK Collaborative HIV Cohort Study (UK CHIC), the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE). Mortality of treated HIV-1 positive individuals according to viral subtype in Europe and Canada: collaborative cohort analysis[END_REF], UK CHIC study [START_REF] Margaret | Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) Study[END_REF], Murray [START_REF] Murray | Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013[END_REF], CASCADE collaboration [START_REF] Wolbers | Pretreatment CD4 cell slope and progression to AIDS or death in HIV-infected patients initiating antiretroviral therapy-the CASCADE collaboration: a collaboration of 23 cohort studies[END_REF], Nakagawa [START_REF] Nakagawa | Life expectancy living with HIV: recent estimates and future implications[END_REF] and Smith RD [START_REF] Smith | HIV transmission and high rates of late diagnoses among adults aged 50 years and over[END_REF], and extrapolated to a 5-year time horizon as a constant hazard utilizing linear regression to numerically assess goodness of a fit and estimate parameters of the Weibull regression, results can be seen in Appendix 1. In particular, mortality risk and survival rates of HIV detected population was divided into 8 categories: >200, 200-350, 350-500, >500 per µL, further by male or female for each early and late detected group, to derive average hazard rate per annum in each newlydiagnosed HIV early (CD4 cell count ≥ 350/µl) and late (CD4 cell count < 350/µl) detected group, for male (M) or female (F). For estimating survival among the population observed, starting risk of death r (hazard rate) was calculated for four groups: 1) newly early detected patients , 2) newly late detected patients, 3) of male gender and 4) of female gender, resulting in Poland with 0.45% (M), 0.29% (F) and 2.75% (M), 1.99% (F) and UK with 0.40% (M), 0.25% (F) and 2.52% (M), 1.83% (F) respectively.

Risk of death was specific to sex, early or late detection and gender, defined as at a CD4 cell count of > 350/µl or < 350/µl respectively. Formulas for the survival probability are represented below: Formula 1 Formula 2 Formula 3 Formula 4 Survival probability appears as the complementary risk of death. Survival function S (t)

represents the estimate of survivors at the beginning of the time period t, and this is a cumulative function calculated as .

If we denote the risk of death in men with and the risk of death in women with and if represents percentage of men, then (1-) represents the percentage of women in the study, so the expected number of survivors is calculated as the sum of the expected number of surviving men and the expected number of surviving women:

Symbols denoting risk of death separated by gender and HIV detection time may be introduced:

For the group of patients aged 0 49, the expected number of surviving men in whom the disease was discovered early is:

, With the expected number of surviving women in whom the disease was detected early is:

. Then, the expected number of survivors at the beginning of the time period t for those in whom the disease was detected early is calculated as the sum of the expected number of surviving men in whom the disease was detected early and the expected number of surviving women in whom the disease was detected early, i.e.:

(Formula 1)

Similarly, the expected number of surviving men in whom the disease was detected early is:

, And the expected number of surviving women in whom the disease was detected early is: , Therefore, the expected number of survivors with late disease detection represents the sum of the expected number of surviving men and women in whom the disease was detected late.

(

This explains the first two formulas i.e. calculation of the expected number of survivors for the group of patients aged 0-49, depending on the gender and the detection time.

Thus, the survival function is used to calculate for each year the expected number of the survivors when the disease is detected early, and the expected number of survivors in the late detection of the disease.

With a group of patients older than 50 in whom the disease was detected late, there is a presumption that the possibility of death is 2.4 times higher than in the patients under the age of 50 in whom the disease was detected early.

To understand the used formula, calculation of the expected number of survivors can be displayed in another way.

If the beginning of the research i.e. the initial year is marked with , the expected number of survivors at the onset will be 100% as that represents the moment of the very beginning of the study. In each subsequent point of observation i.e. year , the expected number of survivors decreases and is calculated as:

I.e.

For example, for t=3, the formula is:

I.e. from the initial 100% of the expected survivors, the risk of death r is deducted for the period between the first and the second year, then the product of survival probability until the second year and the risk of death in the period between the second and the third year are deducted.

If we also include the division in gender, the formula becomes:

The formula we use to calculate the expected number of survivors over the age of 50 in whom the disease was detected late is:

The expected number of survivors over the age of 50 in whom the disease was detected late, in the year t, is calculated when from the originally expected number of survivors over the age of 50 in whom the disease was detected late (100%), we deduct the difference between the value of the expected number of surviving patients under the age of 50 in whom the disease was detected late at the beginning, and the value in the year t multiplied by 2.4, as the risk of death is 2.4 times higher for the patients older than 50 in case of late disease detection than in the patients under the age of 50 in case of late disease detection [START_REF] Smith | HIV transmission and high rates of late diagnoses among adults aged 50 years and over[END_REF].

(we added and deducted )

The difference can be represented as:

We use , because the risk of death is 2.4 times higher than in the patients under the age of 50 in whom the disease was detected late. Further:

And since the survival function at the onset is 100%, we get:

For the patients over the age of 50, in whom the disease was detected early, a risk of death is presumed at 14% of the risk of death in patients over 50 in whom the disease was detected late.

The expected number of survivors over the age of 50 in whom the disease was detected early, in the year t, is calculated when from the originally expected number of survivors over the age of 50 in whom the disease was detected early (100%), we deduct the difference between the value of the expected number of surviving patients over the age of 50 in whom the disease was detected late at the beginning, and the value in the year t multiplied by 14%, as 14% is the ratio between the patients over the age of 50 in case of early disease detection and the patients over the age of 50 in case of late disease detection. The formula is derived as follows:

As in the previous case, we start from:

(we added and subtracted )

The difference can be represented as:

Further:

And since the survival function at the onset is 100%, we get:

This framework allows for modeling of the survival benefits associated with a given shift in the proportion of late and early diagnoses, based on flexible input gender breakdown and starting input death hazard rate. The number of life-years gained over t years from a percentage point shift in the distribution is derived using the hazard rates associated with late and early HIV detection, respectively. Hence, this two state Markov model with HIV patients being in either alive or death state cycles on an annual basis to further estimate total number of patients that may die on an annual basis up to five years term cumulative. Thus, a shift from late to early detection impacted the distribution of patients, which have different survival probabilities.

The assumptions that 7.7 and 16.3 % of all newly-diagnosed HIV infections occur in individuals aged over 50 years, and that 80% and 64% of these are in males in Poland and UK, respectively, were further considered in order to generate the survival probabilities in Table 1 (Panel A -Poland and Panel B -UK) [START_REF] Fronczak | Declaration of Commitment on HIV/AIDS, General Assembly[END_REF][START_REF] Smith | HIV transmission and high rates of late diagnoses among adults aged 50 years and over[END_REF][START_REF]United Kingdom New HIV diagnoses to end of June 2011[END_REF].

Calculation results were validated against the study of life expectancy data from a cohort of recently diagnosed individuals in the Netherlands [START_REF] Van Sighem | Life expectancy of recently diagnosed asymptomatic HIV-infected patients approaches that of uninfected individuals[END_REF].

In the UK, the assumed number of onward transmissions avoided per year per positive patient was 0.02773 [START_REF]Increasing the uptake of HIV testing among men who have sex with men[END_REF]. In case of Poland, due to missing information of onward transmission rate, author used the relationship between prevalence and incidence in the UK and Poland to derive Polish onward transmission rate of 0.02634. As the ratio of UK HIV population was 7.36% 2A) [START_REF] Woods | Country-level cost-effectiveness thresholds: initial estimates and the need for further research[END_REF][START_REF] Smith | HIV transmission and high rates of late diagnoses among adults aged 50 years and over[END_REF][START_REF]United Kingdom New HIV diagnoses to end of June 2011[END_REF]. Therefore, the higher treatment costs reported with late stage detection are not the result of factors correlating with the timing of the HIV diagnosis, but rather reflect the independent effect of an early vs. late diagnosis after controlling for other confounding factors. ISPOR Budget Impact Model -Principles of Good Practice were followed during Sunrise decision model development [START_REF] Sullivan | Budget Impact Analysis-Principles of Good Practice: Report of the ISPOR 2012 Budget Impact Analysis Good Practice II Task Force[END_REF].

There were 1098 HIV, 102 newly-detected AIDS cases and 61 deaths registered in 2013 in Poland. This equates to an estimated new HIV diagnosis rate of 0.29 per 10,000 population [START_REF]Information about HIV infection and AIDS diseases in Poland[END_REF].

There were 6,000 HIV, 320 newly-detected AIDS cases and 530 deaths registered in 2013 in the UK. This equates to an estimated new HIV diagnosis rate of 1.0 per 10,000 population [START_REF] Yin | HIV in the United Kingdom 2014 Report: data to end 2013[END_REF].

Systematic literature review identified total of 102 full-length articles, which fulfilled the criteria based on full review. In the process of full review 70 studies were excluded. Among these 38 represented reviews or commentaries. 30 studies were excluded due to population specificity that had a limited scope of the analysis relating to the specific groups of patients and not directly related to the hypothesis population. pilot National Health Service projects to expand HIV testing [START_REF]Evidence and resources to commission expanded HIV testing in priority medical services in high prevalence areas[END_REF]. The right-hand panels show the breakdown of cost categories that comprise the base-case savings as segments of stacked bars. The top bar segment in white represents the valuation of life-years saved at £20,000

each, so such valuation can be included or excluded by viewing the full bar or only the coloured segments, respectively.

In LSL (population 838,005), an estimated 53 transmitted infections were avoided and 104 lifeyears saved at year 5. These and the cases detected earlier gave rise to projected savings rising from £887,975 in year 1 to a cumulative value of £5,290,206 at year 5. By year 5, the greatest component of the savings was the value of the projected 104 life-years saved. If this was excluded, year 5 cumulative savings were £3,210,206, and the largest components of savings were due to reduced use of "other drugs", ie. drugs for prophylaxis and treatment of HIV complications, followed by savings in inpatient care from avoided hospital admissions. The pattern of use of antiretrovirals showed a decrease in expenditure in year 1, which was eroded over time until by year 5 a small cumulative increase resulted (as more patients remained alive and were therefore exposed to treatment in the future scenario). The savings were insensitive to the transmission rate within the 5-year analytic horizon, but were sensitive in direct proportion to the percentage shift from late to early diagnosis, such that savings would be doubled if a complete (100%) shift to early diagnosis was achieved.

When the potential savings are viewed alongside the possible costs of implementing a program of testing all acute hospital admissions and new GP registrations, it can be seen that cumulative savings from the base-case exceed cumulative costs from year 1 through year 5, and do so without invoking any valuation of life-years saved (see figure IV Panel A).

The components of savings for GMC and the impact of sensitivity analyses show similar proportions as for LSL, but the absolute magnitude of savings is much smaller, at £2,564,802 for the base-case at year 5. This is a consequence of the overall prevalence in GMC standing at 2.1 per 1,000, as compared to 10.97 per 1,000 in LSL, even though the population of GMC is three times that of LSL. An estimated 26 transmitted infections were avoided and 50 lifeyears saved at year 5. The cost impact of implementing testing of all acute admissions and new GP registrants is assumed to be in direct proportion to population for the purposes of this analysis, and as a result, exceeds the projected savings from a 50% shift to early detection, using HPA's cost assumptions (see figure IV Panel B).

K and M has a smaller population than GMC and a lower HIV prevalence, at 0.90 per 1,000. As a result, the potential savings from the base-case are commensurately smaller, at £733,202 to year 5 cumulatively. Seven transmitted infections were avoided and 14 life-years saved at year

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 563,440. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table VII).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 31, 28 and 5 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 351, 190 and 72 days avoided respectfully (Figure VIII).

Number of HIV+ Infections Avoided

Based on the initial 162 newly detected patients in the first year divided 42%/58% between late and early detection with 30-percent relative shift to 30/%70% respectively, or 20 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 2, 3 and 6 respectively (Figure IX).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 1, 2, 5 and 11 life years respectfully.

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 274,778. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table VIII).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 15, 13 and 2 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 171, 93 and 35 days avoided respectfully (Figure XII).

Number of HIV+ Infections Avoided

Based on the initial 79 newly detected patients in the first year divided 42%/58% between late and early detection with 30-percent relative shift to 30/%70% respectively, or 10 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 0, 1, 2 and 3 respectively (Figure XIII).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 0, 1, 3 and 5 life years respectfully.

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 942,435. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table IX).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 52, 46 and 8 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 588, 318 and 121 days avoided respectfully (Figure XVI).

Number of HIV+ Infections Avoided

Based on the initial 272 newly detected patients in the first year divided 42%/58% between late and early detection with 30-percent relative shift to 30/%70% respectively, or 34 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 9 respectively (Figure XVII).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 1, 4, 9 and 18 life years respectfully.

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 21,210,092. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table X).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 1166, 1042 and 179 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 13222, 7150 and 2728 days avoided respectfully (Figure XX).

Number of HIV+ Infections Avoided

Based on the initial 6111 newly detected patients in the first year divided 42%/58% between late and early detection with 30-percent relative shift to 30/%70% respectively, or 770 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 21, 62, 124 and 208 respectively (Figure XXI).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 20, 81, 202 and 404 life years respectfully.

2.4.1) England -DERBYSHIRE AND NOTTINGHAMSHIRE AREA TEAM

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 1,021,437. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XI).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 56, 50 and 9 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 637, 344 and 131 days avoided respectfully (Figure XXIV).

Number of HIV+ Infections Avoided

Based on the initial 294 newly detected patients in the first year divided 42%/58% between late annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 10 respectively (Figure XXV).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 1, 4, 10 and 19 life years respectfully.

2.4.2) England -Leicestershire And Lincolnshire Area Team

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 1,026,264. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XII).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 56, 50 and 9 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 640, 346 and 132 days avoided respectfully (Figure XXVIII).

Number of HIV+ Infections Avoided

Based on the initial 296 newly detected patients in the first year divided 42%/58% between late annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 10 respectively (Figure XXIX).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 1, 4, 10 and 20 life years respectfully.

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 1,020,609. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XIII).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 56, 50 and 9 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 636, 344 and 131 days avoided respectfully (Figure XXXII).

Number of HIV+ Infections Avoided

Based on the initial 294 newly detected patients in the first year divided 42%/58% between late and early detection with 30-percent relative shift to 30/%70% respectively, or 37 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 10 respectively (Figure XXXIII).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 1, 4, 10 and 19 life years respectfully.

2.4.4) England -Hertfordshire And The South Midlands Area Team

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 1,018,231. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XIV).

Resource savings in terms of number of days that could be avoided

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 1,025,416. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XV).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 56, 50 and 9 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 639, 346 and 132 days avoided respectfully

(Figure XL).

Number of HIV+ Infections Avoided

and early detection with 30-percent relative shift to 30/%70% respectively, or 37 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 10 respectively (Figure XLI).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 1, 4, 10 and 20 life years respectfully. 59

2.4.6) England -London North East And Central

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 1,028,041. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XVI).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 57, 50 and 9 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 641, 347 and 132 days avoided respectfully

(Figure XLIV).

Number of HIV+ Infections Avoided

Based on the initial 296 newly detected patients in the first year divided 42%/58% between late annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 10 respectively (Figure XLV).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 1, 4, 10 and 20 life years respectfully.

2.4.7) England -London South

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 1,022,003. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XVII).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 56, 50 and 9 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 637, 345 and 131 days avoided respectfully

(Figure XLVIII).

Number of HIV+ Infections Avoided

and early detection with 30-percent relative shift to 30/%70% respectively, or 37 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 10 respectively (Figure XLIX).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 1, 4, 10 and 19 life years respectfully.

2.4.8) England -London North West

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 1,026,311. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XVIII).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 56, 50 and 9 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 640, 346 and 132 days avoided respectfully

(Figure LII).

Number of HIV+ Infections Avoided

and early detection with 30-percent relative shift to 30/%70% respectively, or 37 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 10 respectively (Figure LIII).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 1, 4, 10 and 20 life years respectfully.

2.4.9) England -Devon, Cornwall And Isles Of Scilly Area Team

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 1,020,190. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XIX).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 56, 50 and 9 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 636, 344 and 131 days avoided respectfully

(Figure LVI).

Number of HIV+ Infections Avoided

and early detection with 30-percent relative shift to 30/%70% respectively, or 37 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 10 respectively (Figure LVI).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 1, 4, 10 and 19 life years respectfully. 67

2.4.10) England -Cumbria, Northumberland, Tyne And Wear Area Team

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 1,025,750. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XX).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 56, 50 and 9 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 639, 346 and 132 days avoided respectfully

(Figure LX).

Number of HIV+ Infections Avoided

Based on the initial 296 newly detected patients in the first year divided 42%/58% between late annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 10 respectively (Figure LXI).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 1, 4, 10 and 20 life years respectfully. 69

2.4.11) England -Lancashire Area Team

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 1,024,058. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XXI).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 56, 50 and 9 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 638, 345 and 132 days avoided respectfully

(Figure LXIV).

Number of HIV+ Infections Avoided

Based on the initial 296 newly detected patients in the first year divided 42%/58% between late annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 10 respectively (Figure LXV).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 1, 4, 10 and 20 life years respectfully.

2.4.12) England -Greater Manchester Area Team

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 1,025,993. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XXII).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 56, 50 and 9 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 640, 346 and 132 days avoided respectfully

(Figure LXVIII).

Number of HIV+ Infections Avoided

Based on the initial 295 newly detected patients in the first year divided 42%/58% between late annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 10 respectively (Figure LXIX).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 1, 4, 10 and 19 life years respectfully.

2.4.13) England -Cheshire, Warrington And Wirral Area Team

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 1,024,248. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XXIII).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 56, 50 and 9 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 639, 345 and 132 days avoided respectfully

(Figure LXXII).

Number of HIV+ Infections Avoided

Based on the initial 295 newly detected patients in the first year divided 42%/58% between late annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 10 respectively (Figure LXXIII).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 1, 4, 10 and 20 life years respectfully.

2.4.14) England -Merseyside Area Team

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 1,021,926. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XXIV).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 56, 50 and 9 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 637, 345 and 131 days avoided respectfully

(Figure LXXVI).

Number of HIV+ Infections Avoided

Based on the initial 294 newly detected patients in the first year divided 42%/58% between late annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 10 respectively (Figure LXXVII).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 1, 4, 10 and 19 life years respectfully.

2.4.15) England -Kent And Medway Area Team

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 1,016,727. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XXV).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 56, 50 and 9 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 634, 343 and 131 days avoided respectfully

(Figure LXXX).

Number of HIV+ Infections Avoided

Based on the initial 293 newly detected patients in the first year divided 42%/58% between late annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 10 respectively (Figure LXXXI).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 1, 4, 10 and 19 life years respectfully.

2.4.16) England -Bath, Gloucestershire, Swindon And Wiltshire Area Team

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 1,026,542. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XXVI).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 56, 50 and 9 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 640, 346 and 132 days avoided respectfully

(Figure LXXXIV).

Number of HIV+ Infections Avoided

Based on the initial 296 newly detected patients in the first year divided 42%/58% between late annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 10 respectively (Figure LXXXV).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 1, 4, 10 and 20 life years respectfully.

2.4.17) England -Bristol, North Somerset, Somerset And South Gloucestershire Area Team

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 1,022,021. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XVII).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 56, 50 and 9 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 637, 345 and 131 days avoided respectfully

(Figure LXXXVIII).

Number of HIV+ Infections Avoided

Based on the initial 294 newly detected patients in the first year divided 42%/58% between late annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 10 respectively (Figure LXXXIX).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 1, 4, 10 and 19 life years respectfully.

2.4.18) England -Birmingham And The Black Country Area Team

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 1,022,998. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XXVIII).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 56, 50 and 9 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 638, 345 and 132 days avoided respectfully

(Figure XCII).

Number of HIV+ Infections Avoided

Based on the initial 295 newly detected patients in the first year divided 42%/58% between late annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 10 respectively (Figure CIII).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 1, 4, 10 and 19 life years respectfully.

2.4.19) England -Hartlepool PCT (Arden, Herefordshire And Worcestershire Area Team)

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 1,026,215. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XXXI).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 56, 50 and 9 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 640, 346 and 132 days avoided respectfully

(Figure XCVI).

Number of HIV+ Infections Avoided

Based on the initial 296 newly detected patients in the first year divided 42%/58% between late annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 10 respectively (Figure XCVII).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 1, 4, 10 and 20 life years respectfully.

2.4.20) England -Shropshire And Staffordshire Area Team

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 1,025,556. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XXX).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 56, 50 and 9 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 639, 346 and 132 days avoided respectfully (Figure C).

Number of HIV+ Infections Avoided

Based on the initial 295 newly detected patients in the first year divided 42%/58% between late annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 10 respectively (Figure CI).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 1, 4, 10 and 20 life years respectfully.

2.4.21) England -North Yorkshire And Humber Area Team

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 1,029,834. This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XXXI).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 57, 51 and 9 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 642, 347 and 132 days avoided respectfully

(Figure CIV).

Number of HIV+ Infections Avoided

Based on the initial 297 newly detected patients in the first year divided 42%/58% between late annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 10 respectively (Figure CV).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0,

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 181,198 (951,288 zl). This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XXXII).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 3, 3 and 0 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 33, 6 and 0 days avoided respectfully (Figure CVIII).

Number of HIV+ Infections Avoided

and early detection with 30-percent relative shift to 30/%70% respectively, or 19 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 10 respectively (Figure CIX).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 0, 2, 4 and 9 life years respectfully.

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 50,378 (264,486 zl). This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XXXIII).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 1, 1 and 0 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 9, 2 and 0 days avoided respectfully (Figure CXII).

Number of HIV+ Infections Avoided

Based on the initial 38 newly detected patients in the first year divided 42%/58% between late annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 0, 0, 1 and 1 respectively (Figure CXIII).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 0, 0, 1 and 2 life years respectfully.

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 58,333 (306,247 zl). This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XXXIV).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 1, 1 and 0 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 11, 2 and 0 days avoided respectfully (Figure CXVI).

Number of HIV+ Infections Avoided

and early detection with 30-percent relative shift to 30/%70% respectively, or 6 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 0, 0, 1 and 1 respectively (Figure CXVII).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 0, 1, 1 and 3 life years respectfully.

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 31,818 (167,044 zl). This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XXXV).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 1, 0 and 0 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 6, 1 and 0 days avoided respectfully (Figure CXX).

Number of HIV+ Infections Avoided

Based on the initial 24 newly detected patients in the first year divided 42%/58% between late and early detection with 30-percent relative shift to 30/%70% respectively, or 3 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 0, 0, 0 and 1 respectively (Figure CXXI).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 0, 0, 1 and 2 life years respectfully.

Cumulative cost savings breakdown

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 51,704 (271,447 zl). This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XXXVI).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 1, 1 and 0 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 9, 2 and 0 days avoided respectfully (Figure CXXIV).

Number of HIV+ Infections Avoided

and early detection with 30-percent relative shift to 30/%70% respectively, or 5 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 0, 0, 1 and 1 respectively (Figure CXXV).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 0, 1, 1 and 3 life years respectfully.

Cumulative cost savings breakdown

Cumulative

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 76,893 (403,690 zl). This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XXXVII).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 1, 1 and 0 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 14, 2 and 0 days avoided respectfully (Figure CXXVIII).

Number of HIV+ Infections Avoided

and early detection with 30-percent relative shift to 30/%70% respectively, or 8 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 0, 1, 1 and 2 respectively (Figure CXXIX).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 0, 1, 2 and 4 life years respectfully.

Cumulative cost savings breakdown

Cumulative

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 302,270 (1,586,918 zl). This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XXXVIII).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 5, 5 and 0 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 55, 10 and 0 days avoided respectfully (Figure CXXXII).

Number of HIV+ Infections Avoided

Based on the initial 58 newly detected patients in the first year divided 42%/58% between late and early detection with 30-percent relative shift to 30/%70% respectively, or 31 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 2, 4 and 7 respectively (Figure CXXXIII).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 1, 3, 7 and 15 life years respectfully.

Cumulative cost savings breakdown

Cumulative

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 29,166 (153,124 zl). This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XXXIX).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 0, 0 and 0 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 5, 1 and 0 days avoided respectfully (Figure CXXXVI).

Number of HIV+ Infections Avoided

and early detection with 30-percent relative shift to 30/%70% respectively, or 3 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 0, 0, 0 and 1 respectively (Figure CXXXVII).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 0, 0, 1 and 1 life years respectfully.

Cumulative cost savings breakdown

Cumulative

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 41,098 (215,765 zl). This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XL).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 1, 1 and 0 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 8, 1 and 0 days avoided respectfully (Figure CXL).

Number of HIV+ Infections Avoided

and early detection with 30-percent relative shift to 30/%70% respectively, or 4 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 0, 0, 1 and 1 respectively (Figure CXLI).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 0, 0, 1 and 2 life years respectfully.

Cumulative cost savings breakdown

Cumulative

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 22,538 (118,323 zl). This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XLI).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 0, 0 and 0 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 4, 1 and 0 days avoided respectfully (Figure CXLIV).

Number of HIV+ Infections Avoided

and early detection with 30-percent relative shift to 30/%70% respectively, or 2 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 0, 0, 0 and 1 respectively (Figure CXLV).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 0, 0, 1 and 1 life years respectfully.

Cumulative cost savings breakdown

Cumulative

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 58,333 (306,247 zl). This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XLII).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 1, 1 and 0 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 11, 2 and 0 days avoided respectfully (Figure CXLVIII).

Number of HIV+ Infections Avoided

and early detection with 30-percent relative shift to 30/%70% respectively, or 6 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 0, 0, 1 and 1 respectively (Figure CXLIX).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 0, 1, 1 and 3 life years respectfully.

Cumulative cost savings breakdown

Cumulative

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 163,067 (856,101 zl). This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XLIII).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 3, 3 and 0 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 30, 5 and 0 days avoided respectfully (Figure CLII).

Number of HIV+ Infections Avoided

and early detection with 30-percent relative shift to 30/%70% respectively, or 17 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 0, 1, 2 and 4 respectively (Figure CLIII).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 0, 2, 4 and 8 life years respectfully.

Cumulative cost savings breakdown

Cumulative

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 19,886 (104,403 zl). This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XLIV).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 0, 0 and 0 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 4, 1 and 0 days avoided respectfully (Figure CLVI).

Number of HIV+ Infections Avoided

Based on the initial 15 newly detected patients in the first year divided 42%/58% between late annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 0, 0, 0 and 0 respectively (Figure CLVII).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 0, 0, 0 and 1 life years respectfully.

Cumulative cost savings breakdown

Cumulative

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 31,818 (167,044 zl). This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XLV).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 1, 0 and 0 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 6, 1 and 0 days avoided respectfully (Figure CLX).

Number of HIV+ Infections Avoided

Based on the initial 24 newly detected patients in the first year divided 42%/58% between late annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 0, 0, 0 and 1 respectively (Figure CLXI).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 0, 0, 0 and 1 life years respectfully.

Cumulative cost savings breakdown

Cumulative

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 143,181 (751,698 zl). This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XLVI).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 2, 2 and 0 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 26, 5 and 0 days avoided respectfully (Figure CLXIV).

Cumulative cost savings breakdown

Cumulative

Total cost savings

Over the 5-year term, total economic value based on 30-percent relative shift to early detection is estimated to 56,856 (298,492 zl). This is indicative of how much money could be potentially spent to turn such policy into reality shift and still remain budget neutral (Table XLVII).

Resource savings in terms of number of days that could be avoided

Based on 30-percent relative shift from Late to Early Detection, there would be considerable number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the first year it will be 1, 1 and 0 days avoided respectfully. Observing cumulative resource savings after five years, results are projected to be 10, 2 and 0 days avoided respectfully (Figure CLXVIII).

123

Number of HIV+ Infections Avoided

Based on the initial 43 newly detected patients in the first year divided 42%/58% between late and early detection with 30-percent relative shift to 30/%70% respectively, or 6 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 0, 0, 1 and 1 respectively (Figure CLXIX).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 0, 1, 3 and 7 life years respectfully.

In both, Polish and UK setting, the direct savings were less sensitive to the transmission rate within the 5-year analytic horizon, but were very sensitive in direct proportion to the percentage shift from late to early diagnosis, such that savings would be more than tripled (332%), if a complete (99.99%) shift to early diagnosis were achieved.

Savings that could be achieved from earlier detection of HIV infection in different countries were estimated. The estimates critically depend on whether the assumed shifts in late to early detection actually occur. For the purposes of the analyses, author has assumed a 30% relative physician visits necessary to address the most relevant population that needs to be HIV tested.

In addition to, HIV prevention interventions targeted at high-risk populations, those associated with the care continuum, and those that reduce the transmission risk of HIV-infected people are typically the most cost-effective [START_REF] Lin | Cost Effectiveness of HIV Prevention Interventions in the US[END_REF]. As such, decision makers may consider these results when building more effective HIV prevention programs.

The range of costs and benefits that are included in the economic calculation depend on the perspectives and attitudes of the decision-maker. For economic evaluations submitted to NICE and Polish HTA Agency, a formal cost-utility analysis is required. Author did not formally utilityadjust survival in this study in the interests of avoiding complexity, but £7,000 in Poland and £20,000 in UK per life-year saved can be taken as a reasonable proxy for both Polish HTA Agency cost-utility threshold of £6,000 -£12,000 and NICE's stated cost-utility threshold of £20,000-£30,000 per QALY gained [START_REF] Publiczny | Hospital of Infectious Diseases in Warsaw, Cennik centralnego laboratorium analitycznego[END_REF]. If the utility of a year spent in asymptomatic HIV+ infection with CD4+ cell count between 200 and 500 cells/µL is 0.933 [START_REF] Schackman | Comparison of Health State Utilities Using Community and Patient Preference Weights Derived from a Survey of Patients with HIV/AIDS[END_REF], a valuation of £21,500 per life year (LY) gained corresponds to £21,500 * 0.933, or approximately £20,000 per LY gained in the UK and £6,500 in Poland. Economic evaluations submitted to NICE should consider all relevant NHS costs, measured over the full period of time that they accrue.

The horizon of this study was limited to 5 years because any investment to hasten HIV detection is likely to have to be self-financing within a short timescale, as "new" money may not be available. Even though relatively few deaths occur in the 5-year timescale, the impact of valuing life-years saved at £20,000 per annum becomes substantial by year 5. In contrast, avoidance of onward HIV transmission has a smaller impact on costs over the 5-year timescale of this analysis, but this effect does compound to become more significant in a lifetime analysis.

This study has a number of limitations. The CD4 level of 350 cells/µL within 3 months of diagnosis as a threshold between early and late detected patients was utilized in both Poland and UK scenario. Even though, 2015 guidelines have raised this threshold, the impact would probably be similar, as higher the CD4 level, the greater the proportion of late detected patients (e.g. <500 cells/µL), but at the same time smaller the gap in savings between late and early detected patient. [START_REF]Increasing the uptake of HIV testing among men who have sex with men[END_REF], which was assumed for Poland, as there was a small difference between two countries when comparing the ratio of newly detected patients to existing HIV patients [START_REF]Annual report infectious diseases and poisonings in Poland[END_REF][START_REF] Niedźwiedzka-Stadnik | HIV and AIDS in Poland in 2013[END_REF]. The actual figure is likely to vary between countries areas according to prevalence. In the absence of data, we performed sensitivity analyses around feasible ranges for this parameter. There was total of 36 and 211 new HIV infections avoided in Poland and UK over the five-year span, respectively (Figure 3). If the study horizon expanded from 5 to 10 or 15 years, there would be a great impact of onward transmissions, however payers are very hesitant to observe study results that expand beyond 5-year horizon.

Another limitation of the study is relating to the barriers to HIV screening. Barriers to HIV screening are numerous and may include: general physician not having the time to ask all the right questions to identify potentially HIV infected patient, or not being familiar with the health conditions associated with HIV, potential patient having fear of a HIV positive test result being reported back to insurance, stigma of facing the family and friends, being identified in the national HIV registry, being identified as gay / bisexual, being seen entering HIV specialist clinic, and above all the experience of having false positive or negative HIV test results.

Using Cochrane Effective Practice and Organisation of Care (EPOC) 2002 taxonomy, these HIV screening barriers translated, could be classified using 9 categories: information management, clinical uncertainty, sense of competence, perceptions of liability, patient expectations, standards of practice, financial disincentives, administrative constraints and other).

UK system is slightly better organizer to handle these barriers, than the Polish. Part of this success is relating to a slightly more open UK culture, as well as regulations, which allow for HIV test being done in any institution vs. a visit to the Polish HIV specialist. Doing HIV testing can be done confidentially in the UK vs. being automatically registered in a Polish national HIV test database. Hence, there might be more investment and regulatory changes needed in Poland vs. UK, to achieve the same prevention results using the same strategies.

The results of the study clearly show that a shift from the late detection of the HIV prevalence to the detection at the early stages will enable a budgetary saving that can be used towards The systematic literature review found 102 articles that were based on the full review.

However, 70 of the reviews were excluded from the study. 29 reviews were removed from the study due to the specifications on the population, which had a small scope of the analysis related to the different categories of the patients. In the design of the Sunrise model, 32

reviews and commentaries were incorporated [START_REF] Mellors | Plasma viral load and CD4+ lymphocytes as prognostic markers of HIV-1 infection[END_REF]. Thirty percent relative shift of the detection of the virus from the 42% to the 29.4% of the late detections of the disease over the past five years, in the United Kingdom, would result in an estimated direct income and saving of about 28,811 Euros per patient. Besides, it would lead to the increase in the life expectancy, and avoidance of more than 200 cases of the virus infections. In the Southwark and Lewisham (LSL) population of 838,005, about 53 of the transmission infections were shun for the past five years [START_REF] Egger | Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies[END_REF]. The avoidance of the infections increased the savings of the individual involved to a total of about three million Euros after the five years of the study.

The Geometric mean concentrations (GMC) impacts of the sensitive analyses were similar to the LSL [START_REF] Mellors | Plasma viral load and CD4+ lymphocytes as prognostic markers of HIV-1 infection[END_REF]. However, in the GMC, the magnitude of the saving is quite smaller than in the LSL. The GMC exhibits savings amounting to more than 2.5 million Euros after the study. The K and M has a smaller population compared to the GMC. This leads to a reduced prevalence of the virus at 0.90 per 1,000 individuals. This results in a reduced total base savings of 733,202 Euros after the five years of the study [START_REF] Rodger | Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPRIT trials compared with the general population[END_REF]. The cumulative life years saved due to a thirty percent shift from the late detection to early detection and diagnosis for the years 1, 2, 3, 4, and 5 would be 0, 1, 2, 5, and 11 life years respectfully [START_REF] Egger | Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies[END_REF]. In all the three settings, there would be certain days that would be avoided based on the thirty percent relative shift from the late to the early detection of the HIV. The total economic value based on the 30% shift over the There was an increase in the Annual cART cost with progressive savings in other settings. In the other drug category, which is non-HIV and the Inpatient care units, a substantial amount of savings was recorded. The total cost savings after the five-year term of study based on the thirty percent shift from the late stage to early stage detection was approximated to be 306,247

Zl, which is equivalent to 58,333 Euros. This kind of economic value is an indicative of the amount of money to be spent in the reality shifting of the policy, whilst preserving budget neutrality.

In all the three settings, the Outpatient care, the Inpatient, and in the Day Ward care, there would be an increased shift from the late to the early detections of the virus based on the allocated thirty percent [START_REF] Mellors | Plasma viral load and CD4+ lymphocytes as prognostic markers of HIV-1 infection[END_REF]. 1, 1, and 0 days would be avoided in the first year which would result to 11, 2, and o days after the five-year study term. With reference to the thirty-nine newly detected cases of the virus in the first year divided 42%/58% between the early and the late detection of the HIV, with a thirty percent shift to 30%/70% respectively would account for the virus incidences and the transmission multiplier scalar for the number of the HIV infections prohibited. The cumulative life years saved due to the thirty percent relative shift to the early stages detection from the late detection of the HIV and AIDS [START_REF] Rodger | Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPRIT trials compared with the general population[END_REF].

In the research, the savings due to the early detection of the infection by the HIV in the patients were approximated. The estimates were dependents of whether the assumption made in the late detection took place. To enable the working of the data, an assumed shift of thirty percent was used, which led to the reduction of the late diagnosis of the HIV from 42% to 29% in the United Kingdom and 46% to 32.2% in the Republic of Poland [START_REF] British Hiv Association | BHIVA guidelines for the treatment of HIV-1 positive adults with antiretroviral therapy 2012[END_REF]. Scientist found the 30% figure essential to the study since the success would have been viewed as the minimum credible outcome for the extensive testing program to be considered effective [START_REF] Egger | Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies[END_REF]. Poland has some fixed annual reimbursements policies per capita for the ambulatory care and the antiretroviral therapy administered to the patients [START_REF] Egger | Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies[END_REF].

In the United Kingdom, the early detection shift from the 58% to the 70.6% caused an instant increase in the number of patients to 785 per year or cumulatively to 3,923 after the five years of the study. The study clearly indicated that if the National Health Service could deploy the projected savings of the twenty-one million Euros to capture the 3,923 patients, it would require a detection of 9,350 cases of the virus infected patients [START_REF] Lin | Cost Effectiveness of HIV Prevention Interventions in the US[END_REF]. Seven to eleven infections were recorded in individuals in the London and Leicester cities. In Brighton, fewer cases of less than two patients per 1, 000 tests were established. This turned to be a surprising degree due to the huge number of the residents in the cities. The study found that increased number of HIV detection tests would increase the chances of individuals conducting the tests and early detection the diseases as well as a reduction in the costs of undertaking the tests [START_REF] Rodger | Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPRIT trials compared with the general population[END_REF].

The tests to be used should be accurate not to give out false results that would result in poor responses to the medical requirements of the individuals as well as government support and usage of the money. The recorded cost effective techniques are the ones targeted at the highrisk populations, who are normally associated with the care gamut. The policy and decision makers are advised to consider the allocated methods for the tests in the construction of better and more efficient HIV spread prevention techniques [START_REF] British Hiv Association | BHIVA guidelines for the treatment of HIV-1 positive adults with antiretroviral therapy 2012[END_REF]. The attitude of the policy makers is of the essence in the calculation of the costs of the tests and benefits incurred to the patients while budgeting for the economic status. An official evaluation of the economic status of the two nations is required for any submission made to the National Institute for Health and Care Excellence (NICE) in the United Kingdom and the Polish Health Technology Assessment (HTA) Agency. The study also exhibited outlined demerits [START_REF] Rodger | Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPRIT trials compared with the general population[END_REF]. It has been discovered that the CD4 count of 350 cells/µL was used within three hours in the United Kingdom as well as in the Republic of Poland. The national prospective monitoring system that is being used to record the care provided to the patients by several hospital in early 1996 [START_REF] Lin | Cost Effectiveness of HIV Prevention Interventions in the US[END_REF]. The Euro (£) was calculated on the actual Great Britain Pound (GBP) and the Polish Zloty (PLN) values. Early detection of the disease increases the chances of survival of the individual infected with the long-term virus. The virus has no cure, and the late detection will lead to a lowered lifespan of the patient, who requires a lot of money for the individual to survive.

Results of this study indicate that in the case of two financially different healthcare systems, shift from late to early HIV detection will create budgetary savings that could be re-directed towards HIV testing. However, re-directed funds on their own will not be enough, as the current cost per HIV test is above the estimated required cost for a breakeven point. Thus, either a cost drop per HIV test due to greater consumption or further additional investment will be required to achieve budget neutrality.

Faculté

  Techniques des Activités Physiques et Sportives Observatoire des Sciences de l'Univers de Lyon Polytech Lyon Ecole Supérieure de Chimie Physique Electronique Institut Universitaire de Technologie de Lyon 1 Ecole Supérieure du Professorat et de l'Education Institut de Science Financière et d'Assurances Directeur : M. F. DE MARCHI Directeur : M. le Professeur F. THEVENARD Directeur : Mme C. FELIX Directeur : M. Hassan HAMMOURI Directeur : M. le Professeur S. AKKOUCHE Directeur : M. le Professeur G. TOMANOV Directeur : M. le Professeur H. BEN HADID Directeur : M. le Professeur J-C PLENET Directeur : M. Y.VANPOULLE Directeur : M. B. GUIDERDONI Directeur : M. le Professeur E.PERRIN Directeur : M. G. PIGNAULT Directeur : M. le Professeur C. VITON Directeur : M. le Professeur A. MOUGNIOTTE Directeur : M. N. LEBOISNE

  Europe with 54% of 84,524 patients that diagnose late per results of 35 European countries within Collaboration of Observational HIV Epidemiological Research in Europe (COHERE) study during the time period of 2000-2011(2).

  services for adults and children, and cost of antiretroviral treatment including drugs for pre-exposure prophylaxis ( PrEP) Antenatal screening All sexual health services in secure and detained settings Sexual assault referral centres

  the HIV testing. The cost of undertaking the test should be lowered to allow many people access the service. The government should also introduce measures to prohibit the private sector, which increases the costs of undergoing the test. It has been established that each year many individuals in the world succumb to death due to the development of the Acquired Immunodeficiency Syndrome (AIDS)[START_REF] Egger | Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies[END_REF]. The treatment of the disease has not yet been discovered. The current medications aids in the suppression of the development of the virus as its progression rate is lowered. The use of the anti-retroviral drugs has increased the chances of the survival of the patients. It has been studied that five people become infected with the disease for every two person that accesses the therapies. Scientists have shown the essence of early detection of the diseases as most of the youths whose infection is detected while at the toddler age have increased chances of living a normal life[START_REF] Beck | The cost-effectiveness of early access to HIV services and starting cART in the UK, 1996-2008[END_REF].The individual members of the parliament and policy makers are not conscious of the actual complications developed by the patients and the savings incurred while switching from the late to the early detection of the AIDS. Studies have shown that the legislators are not conversant with the investment to experience budget neutrality. Scientists have tried to make these terms clear through the establishment of studies relating to the actual categories of the patients problems. The research indicated the trouble the disease brings to the affected family members. The effects of the early versus the late HIV detection in the United Kingdom and Poland was measured according to the humanistic, economic, as well as the clinical burdens imposed on the society and government by the patients[START_REF] Egger | Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies[END_REF].The study was conducted in three different categories. The first stage was a systematic literature review that explains the burden the illness through the relationship between the early and the late detection of the HIV. The review was carried out through the CRD, EMBASE, and the MEDLINE to aid in the establishment of the guidelines and clinical trials as well as the methodology section that was published between 2008 and 2016 in the 26 European Union countries, the United States of America, Canada, and the Non-European Union Central European nations. The second stage was the modeling of the decision to be used in the regions of the United Kingdom and Poland. The ISPOR's governance principles were used to construct the decision model for the effects of the budget analysis guidelines. The final stage was to integrate the Sunrise modeling the committee on HIV and AIDS in the United Kingdom as it was presented in the UK's Parliament, the House of the Lords[START_REF] Beck | The cost-effectiveness of early access to HIV services and starting cART in the UK, 1996-2008[END_REF]. More than thirty thousand individuals in the Republic of Poland were infected with the virus, with the majority number being not aware of the disease as of 2008. Males were found to be high prevalent to the development of the illness. In the United Kingdom, about 107, 800 were recorded to possess the virus with about 24% being unaware of their condition. A late diagnosis of the disease, which is due to the decrease of the CD4 count to less than 350 cells/µl. Early HIV detection of the virus helps in increasing the life expectancy of the patient as well as the reduction in the costs incurred. The governments in both countries give out clear national guidelines on the benefits of having the test to aid in early diagnosis before the virus become complete and in multiple numbers[START_REF] Appleby | Searching for cost effectiveness thresholds in the NHS[END_REF]. Sunrise was found to predict the importance of the early detection of the disease that would aid in the reduction of the medical costs as well as increase the chances of survival of the patient (The Antiretroviral Therapy Cohort Collaboration (ART-CC), Canadian Observational Cohort Collaboration (CANOC), the UK Collaborative HIV Cohort Study (UK CHIC), the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE), 2016).The selection of the keywords in the study was a frequentative activity. The term HIV detection was found to have multiple interpretations with some having it as a diagnosis while others have it as presentation[START_REF] Mocroft | Risk Factors and Outcomes for Late Presentation for HIV-Positive Persons in Europe: Results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE)[END_REF]. The study was found to include all people of all ages regardless of their occupation as long as an individual has developed the illness. The study was conducted different with many keywords, life expectancy, and mortality rate being included. MEDLINE, CRD, Cochrane Library, and the EMBASE were on the forefront benchmark to conduct a literature reviews regarding the clinical trials, reports and the guidelines that had been published in the United Kingdom, Wales, Scotland, United States, Northern Ireland, England, Australia, Canada, and Norway among other nations of the EU-26[START_REF] Egger | Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies[END_REF]. The systematic and successful literature review shown that the study design key parameters were effectively established to prepare the solution to the research question. The details for the understanding of the used parameters can be found in the section of the model framework. The research was found to provide information regarding the native nationals whereby the foreign national were excluded from the study. Scientists found that the viral load of the virus is an essential laboratory indicator of the functioning of the immune system in the infected individuals[START_REF] Rodger | Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPRIT trials compared with the general population[END_REF].The assessment was established by the Effective Public Health Practice Project (EPHPP) criteria. The author had to rate the quality of the components under study in the form of the study design, biasness, blinding, methods of data collection, confounders, integrity of the intervention, as well as the withdrawals. The reviewer of the study rated all the components as strong, moderate, or weak. The Sunrise, which is user-friendly Microsoft excel program with the graphical user interface, was designed to approximate the potential savings of the budget and the survival consequences of the detection of the virus from individuals while on the early stages of development. The program observed the activities of the disease for a time interval of five years as it is the most appropriate period for the best decision making as well as the policy makers could consider. The survival of the aged, whose disease had developed to the maturity stages was conducted based on the COHERE study for five years. The virus detected in the patient was categorized into eight different groups.The hazardous rate was influenced by the patient's age, sex, and the period of the detection, whether early or late. The per annum costs to cater for the disease was the total sum of all the categories of the HIV and AIDS clinical care from a patient's perspective viewpoint[START_REF] Appleby | Searching for cost effectiveness thresholds in the NHS[END_REF]. This included the inpatients, day patient cares, the outpatients, costs of the ART based on the current NFZRepublic of Poland NFZ and guidelines of the British HIV Association (the BHIVA)[START_REF] Mocroft | Risk Factors and Outcomes for Late Presentation for HIV-Positive Persons in Europe: Results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE)[END_REF]. In the Republic of the Poland, there existed 1098 cases of the viral disease as on the time for the study with102 being the newly recognized cases of the disease and 61 as the total number of the registered deaths in the year 2013. In the United Kingdom, on the other hand, the estimated cases were 6,000 with 320 newly detected cases and death toll of 530 patients in the same year. This translates to an approximated diagnosis of the disease rate of 1.0 person per 10,000 people (The Antiretroviral Therapy Cohort Collaboration (ART-CC), Canadian Observational Cohort Collaboration (CANOC), the UK Collaborative HIV Cohort Study (UK CHIC), the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE), 2016).

  five years can be estimated to be approximately 563,000 Euros. These amounts indicate the potential used to turn the policy into a real shift and maintain the budget neutrality. The breakdown was observed in six different categories, which are Inpatient care, Day ward setting Outpatient care, other non-HIV Drug cost, annual cart cost, and Tests & Procedures with respectfully. In the Republic of the Poland, a 30% shift of the virus detected was established. The direct saving after five years would sum up to 1,326 Euros per patient. The life expectancy would increase by additional 61 years and 36 cases of the virus would be avoided. The cost of the test in three different locations in the Poland was about five to six Euros per test par patient. It was established that the figures should be considered as indicative ones since once implemented they could be dragged down by the scope, learning effects, as well as the economies of scale (26). The study in the Republic of Poland was conducted in deferent locations namely the Kujawskopomorskie, Lubelskie, Lubuskie, Lodzkie, Malopolskie, Mazowieckie, Opolskie, Podkarpackie, Podlaskie, Pomorskie, Slaskie, Swietokrzyskie, Zachodniopomorskie, mazurskie -Wielkopolskie, and the Warminsko. On average, the cumulative costs in the different areas based on the six categories, which are Other Drug cost, Inpatient care, annual cART cost, Outpatient care, Day ward setting, and the Tests & Procedures, after the five years of the critical study were £16,259, £25,385, £15,276, £1,091, £0, and the £321 respectfully (26).

  The costs of the test in three settings in the Poland were established to be approximately five to six Euros. The costs were considered indicative of the scope, leaning effects, and the economies of scale could deter them. No evidence has yet been recorded indicating the quantitative relationship between the number of tests to be conducted and the resulting shift to the early detection. It was found that in Poland the total amount of the screen tests carried out nationally in 2013 showed a 0.6 HIV+ cases per 1,000 individuals. The early detection increased to 750 patients after the five years due to the allocated thirty percent shift. The late detection patients embody more than 46% of the infections of the HIV[START_REF] Mocroft | Risk Factors and Outcomes for Late Presentation for HIV-Positive Persons in Europe: Results from the Collaboration of Observational HIV Epidemiological Research Europe Study (COHERE)[END_REF]. The recorded National Health Service allocated costs to capture the 750 early infections detected patients were more than 1.4 million Euros, according to the conducted studies. The study failed to capture some of the patients as

FigFig

  Fig I. The systematic literature review flow

FigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFigFig

  Fig VI. Wales (All LHB), UK -Financial impact of proposed versus current scenario with 30% relative shift towards early HIV detection

  Embase search provided 3,776 records per query as follows:'hiv' AND ('early' OR 'late') AND ('testing' OR 'mortality' OR 'survival' OR 'life' OR 'expectancy'

	OR 'life expectancy' OR 'detection' OR 'diagnosis' OR 'presentation') AND ('uk' OR 'great
	britain' OR 'great' AND 'britain' OR 'united' AND 'kingdom' OR 'united kingdom' OR 'france' OR
	'germany' OR 'denmark' OR 'sweden' OR 'norway' OR 'finland' OR 'poland' OR 'czech republic'
	OR 'czech' AND 'republic' OR 'slovakia' OR 'italy' OR 'spain' OR 'portugal' OR 'slovenia' OR
	'hungary' OR 'roumania' OR 'greece' OR 'serbia' OR 'montenegro' OR 'albania' OR 'moldavia'
	OR 'lithuania' OR 'latvia' OR 'estonia' OR 'netherlands' OR 'belgium' OR 'luxembourg' OR
	'liechtenstein' OR 'iceland' OR 'switzerland' OR 'macedonia' OR 'fyrom' OR 'usa' OR 'united
	states' OR 'canada') AND (2008:py OR 2009:py OR 2010:py OR 2011:py OR 2012:py OR
	2013:py OR 2014:py OR 2015:py OR 2016:py)

("2008/01/01"[PDAT] : "2016/04/04"[PDAT]),

budget impact savings to cover cost of testing

	Figure III represents the impact in terms of number of avoided HIV individuals due to a 30% panel shows the total savings under the base-case future scenario (30% shift from late to early
	relative shift from late to early detection. diagnosis, 2.773% transmission rate) and the alternative future scenarios. Also shown are
	indicative costs based on estimates made by the UK Health Protection Agency (HPA) from
	In the UK, 30% relative shift in HIV detection from 42% to 29.4% late detected HIV patients,
	over 5 years, would result in estimated direct NHS 21,608,562 savings, 28,811 savings per
	infected person, 411 life years gained and 212 HIV infections avoided. If a broader societal
	perspective is used, monetizing life years saved, total savings would be 29,834,679. Sunrise
	results are similar to the existing research that estimated cost per additional life-year saved in
	the range of 2,960 to 4,639 depending on CD4 cells/mm3 at the point of presentation (47,
	48).
	30% relative HIV detection shift to early-detection in the UK also resulted in instant 785 per
	year or 3923 early-detected patients over the five-year span. If the NHS projected cost savings
	of 21,608,562 are deployed to capture this 3923 early-detected patients, it would meant that it
	would require a detection of at least 9,350 new HIV infected individuals, based on the premise
	that late detected patients represent 42% of all newly-detected individuals; assuming a
	detection rate of 2 per 1,000, after 4,672,500 completed tests, with the required maximum cost
	per test of 4.62, cost savings would be neutral. If we assume a detection rate of 3 per 1,000,
	the cost per test could rise to a maximum of 6.93 for cost savings to remain neutral. With the
	value of life years saved, cost of the test could rise to a maximum of 6.20 and 9.29,
	Figures IIA and IIB illustrate graphically the cumulative financial impact of achieving 30%
	relative shift to early diagnosis and its breakdown for UK and Poland, respectively. In each respectively.
	figure, the total cumulative savings are presented.
	Utilizing Figure IV (Panel A,B andC) graphically illustrate the cumulative financial impact of achieving
	shifts to early diagnosis for LSL, GMC, and K and M, respectively. In each figure, the left-hand

2 studies were excluded due to methodological considerations. Thus, 32 studies were included and incorporated in the design of the Sunrise model.

Cumulative cost savings breakdown

	Cumulative cost savings breakdown observed six different categories: Inpatient care,
	Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests &
	Procedures with the following (costs) / savings at year 5 respectfully 341,058, 36,863,
	56,651, 11,539, 493,390 and 81,936. It is of interest to note that there was an increase
	in cost in only one category Annual cART costs and substantial savings in the rest of the
	categories (Table XI). Highest amount of cost savings appeared in other drug (non-HIV)
	category and Inpatient care setting.

53 2.4.3) England -East Anglia Area Team Cumulative cost savings breakdown

	Cumulative cost savings breakdown observed six different categories: Inpatient care,
	Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests &
	Procedures with the following (costs) / savings at year 5 respectfully 340,782, 36,833,
	56.605, 11,529, 492,990 and 81,870. It is of interest to note that there was an increase
	in cost in only one category Annual cART costs and substantial savings in the rest of the
	categories (Table XIII). Highest amount of cost savings appeared in other drug (non-HIV)
	category and Inpatient care setting.

.5) England -Essex Area Team Cumulative cost savings breakdown

	and early detection with 30-percent relative shift to 30/%70% respectively, or 37 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 1, 3, 6 and 10 respectively (Figure XXXVII). 2.4Cumulative cost savings breakdown observed six different categories: Inpatient care,
	Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests &
	Cumulative Life Years Saved
	Procedures with the following (costs) / savings at year 5 respectfully 342,387, 37,007,
	Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for
	56.872, 11,583, 495,312 and 82,255. It is of interest to note that there was an increase
	year 1, 2, 3, 4, 5 will be 0, 1, 4, 10 and 19 life years respectfully.
	in cost in only one category Annual cART costs and substantial savings in the rest of the
	categories (Table XV). Highest amount of cost savings appeared in other drug (non-HIV)
	category and Inpatient care setting.
	Based on 30-percent relative shift from Late to Early Detection, there would be considerable
	number of days avoided in all three settings: Inpatient, Outpatient Care and Day Ward; in the
	first year it will be 56, 50 and 9 days avoided respectfully. Observing cumulative resource
	savings after five years, results are projected to be 635, 343 and 131 days avoided respectfully
	(Figure XXXVI).
	Number of HIV+ Infections Avoided
	57

  Cumulative cost savings breakdown observed six different categories: Inpatient care, Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests & Procedures with the following (costs) / savings at year 5 respectfully 343,264, 37,101, 57.017, 11,613, 496,580 and 82,466. It is of interest to note that there was an increase

in cost in only one category Annual cART costs and substantial savings in the rest of the categories (Table

XVI

). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  Cumulative cost savings breakdown observed six different categories: Inpatient care, Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests & Procedures with the following (costs) / savings at year 5 respectfully 341,247, 36,883,

56,682, 11,545, 493,663 and 81,982. It is of interest to note that there was an increase in cost in only one category Annual cART costs and substantial savings in the rest of the categories (Table XVII). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  Cumulative cost savings breakdown observed six different categories: Inpatient care, Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests & Procedures with the following (costs) / savings at year 5 respectfully 342,686, 37,039,

56,921, 11,594, 495,744 and 82,327. It is of interest to note that there was an increase in cost in only one category Annual cART costs and substantial savings in the rest of the categories (Table XVIII). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  Cumulative cost savings breakdown observed six different categories: Inpatient care, Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests & Procedures with the following (costs) / savings at year 5 respectfully 340,642, 36,818,

56,582, 11,524, 492,778 and 81,836. It is of interest to note that there was an increase in cost in only one category Annual cART costs and substantial savings in the rest of the categories (Table XIX). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  Cumulative cost savings breakdown observed six different categories: Inpatient care, Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests & Procedures with the following (costs) / savings at year 5 respectfully 342,499, 37,019, 56,890, 11,587, 495,473 and 82,282. It is of interest to note that there was an increase

in cost in only one category Annual cART costs and substantial savings in the rest of the categories (Table

XX

). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  Cumulative cost savings breakdown observed six different categories: Inpatient care, Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests & Procedures with the following (costs) / savings at year 5 respectfully 341,934, 36,958, 56,796, 11,568, 494,656 and 82,147. It is of interest to note that there was an increase

in cost in only one category Annual cART costs and substantial savings in the rest of the categories (Table

XXI

). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  Cumulative cost savings breakdown observed six different categories: Inpatient care, Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests & Procedures with the following (costs) / savings at year 5 respectfully 342,580, 37,027, 56,904, 11,590, 495,591 and 82,302. It is of interest to note that there was an increase

in cost in only one category Annual cART costs and substantial savings in the rest of the categories (Table

XXII

). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  Cumulative cost savings breakdown observed six different categories: Inpatient care, Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests & Procedures with the following (costs) / savings at year 5 respectfully 341,997, 36,964, 56,807, 11,570, 494,748 and 82,162. It is of interest to note that there was an increase

in cost in only one category Annual cART costs and substantial savings in the rest of the categories (Table

XXIII

). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  Cumulative cost savings breakdown observed six different categories: Inpatient care, Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests & Procedures with the following (costs) / savings at year 5 respectfully 341,222, 36,881, 56,678, 11,544, 493,626 and 81,976. It is of interest to note that there was an increase

in cost in only one category Annual cART costs and substantial savings in the rest of the categories (Table

XXIV

). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  Cumulative cost savings breakdown observed six different categories: Inpatient care, Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests & Procedures with the following (costs) / savings at year 5 respectfully 339,486, 36,693, 56,390, 11,485, 491,115 and 81,558. It is of interest to note that there was an increase

in cost in only one category Annual cART costs and substantial savings in the rest of the categories (Table

XXV

). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  Cumulative cost savings breakdown observed six different categories: Inpatient care, Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests & Procedures with the following (costs) / savings at year 5 respectfully 342,763, 37,047, 56,934, 11,596, 495,856 and 82,346. It is of interest to note that there was an increase

in cost in only one category Annual cART costs and substantial savings in the rest of the categories (Table

XXVI

). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  1, 4, 10 and 20 life years respectfully.

	With 30% relative shift in HIV detection from 46% to 32.2% late detected HIV patients, over 5
	years, would result in estimated direct NFZ £1,438,050 (7,549,768 PLN), £1,326 (6,960 PLN)
	savings per infected individual, 61 life years gained and 36 HIV infections avoided. If a broader Cumulative cost savings breakdown
	societal perspective is used, monetizing life years saved, total savings would be £1,923,867 Cumulative cost savings breakdown observed six different categories: Inpatient care,
	(10,100,303 PLN). Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests &
	Procedures with the following (costs) / savings at year 5 respectfully 78,854 (413,984 zl),
	3,390 (17,798 zl), 0, 47,451(249,118 zl), 50,504 (265,146 zl) and 998 (5239,5 zl). It is

If the NFZ projected cost savings are deployed to capture this 750 early-detected patients, it would require a detection of at least 1,630 all new HIV infected individuals, based on the premise that late-detected patients represent 46% of all newly-detected individuals; assuming a detection rate of 2 per 1,000, after 815,000 completed tests, with the required maximum cost per test of £1.76 (9.26 PLN), cost savings would be neutral. If we assume a detection rate of 3 per 1,000, the cost per test could rise to a maximum of £2.64 (13.89 PLN) for cost savings to remain neutral. With the value of life years saved, cost of the test could rise to a maximum of £2.36 (12.39 PLN) and £3.54

(18.

59 PLN), respectively.

The cost per test in three different Polish settings ranged £5,71-6.28

[START_REF] Margaret | Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) Study[END_REF][START_REF]The UK Collaborative HIV Cohort Study (UK CHIC), the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE). Mortality of treated HIV-1 positive individuals according to viral subtype in Europe and Canada: collaborative cohort analysis[END_REF][START_REF] Murray | Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013[END_REF][START_REF] Wolbers | Pretreatment CD4 cell slope and progression to AIDS or death in HIV-infected patients initiating antiretroviral therapy-the CASCADE collaboration: a collaboration of 23 cohort studies[END_REF]

. These costs must be considered indicative only and it is conceivable that, once implemented, they could be reduced by economies of scale, scope and learning effects. Evidence is lacking on the quantitative relationship linking the number of tests likely to be performed following a policy decision and the resulting shift to early detection. In Poland, 1,574,320 screening tests were performed nationally in 2013 with 0.6 HIV positive cases per 1,000, whereas excluding blood donors resulted in 2.7 per 1,000

[START_REF]Annual report infectious diseases and poisonings in Poland[END_REF]

. of interest to note that there was an increase in cost in only one category Annual cART costs and substantial savings in the rest of the categories (Table

XXXII

). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  cost savings breakdown observed six different categories: Inpatient care, Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests & Procedures with the following (costs) / savings at year 5 respectfully 33,463 (175,681 zl), 1,439 (7,555 zl), 0, 20,136 (105,704 zl), 21,432 (112,518 zl) and 424 (2,226 zl). It is of interest to note that there was an increase in cost in only one category Annual cART costs and substantial savings in the rest of the categories (Table XXXVII). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  cost savings breakdown observed six different categories: Inpatient care, Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests & Procedures with the following (costs) / savings at year 5 respectfully 131,543 (690,601 zl), 5,656 (29,694 zl), 0, 79,157 (415,574 zl), 84,250 (442,313 zl) and 1,665 (8,741 zl). It is of interest to note that there was an increase in cost in only one category Annual cART costs and substantial savings in the rest of the categories (Table XXVIII). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  cost savings breakdown observed six different categories: Inpatient care, Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests & Procedures with the following (costs) / savings at year 5 respectfully 12,693 (66,638 zl), 546 (2,867 zl), 0, 7,638 (40,100 zl), 8,129 (42,677 zl) and 161 (845 zl). It is of interest to note that there was an increase in cost in only one category Annual cART costs and substantial savings in the rest of the categories (Table XXXIX). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  cost savings breakdown observed six different categories: Inpatient care, Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests & Procedures with the following (costs) / savings at year 5 respectfully 17,885 (83,896 zl), 769 (4,037 zl), 0, 10,763 (56,506 zl), 11,455 (60,139 zl) and 226 (1,187 zl). It is of interest to note that there was an increase in cost in only one category Annual cART costs

and substantial savings in the rest of the categories (Table

XL

). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  cost savings breakdown observed six different categories: Inpatient care, Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests & Procedures with the following (costs) / savings at year 5 respectfully 9,808 (51,492 zl), 422 (2,216zl), 0, 5,902 (30,986 zl), 6,282 (32,981 zl) and 124 (651 zl). It is of interest to note that there was an increase in cost in only one category Annual cART costs and substantial savings in the rest of the categories (Table XLI). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  cost savings breakdown observed six different categories: Inpatient care, Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests & Procedures with the following (costs) / savings at year 5 respectfully 25,385 (133,271 zl), 1,091 (5,728 zl), 0, 15,276 (80,199 zl), 16,259 (85,360 zl) and 321 (1,685 zl). It is of interest to note that there was an increase in cost in only one category Annual cART costs and substantial savings in the rest of the categories (Table XLII). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  cost savings breakdown observed six different categories: Inpatient care, Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests & Procedures with the following (costs) / savings at year 5 respectfully 70,964 (372,561 zl), 3,051 (16,018 zl), 0, 42,703 (224,191 zl), 45,451 (238,618 zl) and 898 (4,715 zl). It is of interest to note that there was an increase in cost in only one category Annual cART costs and substantial savings in the rest of the categories (Table XLIII). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  cost savings breakdown observed six different categories: Inpatient care, Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests & Procedures with the following (costs) / savings at year 5 respectfully 8,654 (45,434 zl), 372 (1,953 zl), 0, 5,208 (27,342 zl), 5,543 (29,101 zl) and 110 (578 zl). It is of interest to note that there was an increase in cost in only one category Annual cART costs and substantial savings in the rest of the categories (Table XLIV). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  cost savings breakdown observed six different categories: Inpatient care, Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests & Procedures with the following (costs) / savings at year 5 respectfully 13,847 (72,697 zl), 595 (3124 zl), 0, 8,332 (43,743 zl), 8,868 (46,557 zl) and 175 (919 zl). It is of interest to note that there was an increase in cost in only one category Annual cART costs and substantial savings in the rest of the categories (Table XLV). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  cost savings breakdown observed six different categories: Inpatient care, Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests & Procedures with the following (costs) / savings at year 5 respectfully 62,310 (327,128 zl), 2,679 (14,065 zl), 0, 37,495 (196,849 zl), 39,908 (209,517 zl) and 789 (4,142 zl). It is of interest to note that there was an increase in cost in only one category Annual cART costs and substantial savings in the rest of the categories (Table XLVI). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  cost savings breakdown observed six different categories: Inpatient care, Outpatient care, Dayward setting, annual cART cost, Other Drug cost (non-HIV), Tests & Procedures with the following (costs) / savings at year 5 respectfully 24,743 (129,901 zl), 1,064 (5,586 zl), 0, 14,889 (78,167), 15,847 (83,197 zl) and 313 (1,643 zl). It is of interest to note that there was an increase in cost in only one category Annual cART costs

and substantial savings in the rest of the categories (Table

XLVII

). Highest amount of cost savings appeared in other drug (non-HIV) category and Inpatient care setting.

  Asthe scenarios show, the main driver of cost savings is the shift actually achieved from late to early diagnosis: a 100% shift whereby virtually all cases were diagnosed early would more than

	30% relative HIV detection shift to early-detection in the UK (from 58% to 70.6% early detected
	patients) resulted in instant 785 per year or 3923 early-detected patients over the five-year
	triple the savings. span. If the NHS projected cost savings of £21,608,562 are deployed to capture this 3923
	early-detected patients, it would meant that it would require a detection of at least 9,350 new
	30% relative HIV detection shift to early-detection in Poland (from 54% to 67.8% early detected HIV infected individuals, based on the premise that late detected patients represent 42% of all
	patients) resulted in instant 150 per year or 750 early-detected patients over the five-year newly-detected individuals; assuming a detection rate of 2 per 1,000, after 4,672,500
	span. If the NFZ projected cost savings of £1,438,050 (7,549,764 PLN) are deployed to completed tests, with the required maximum cost per test of £4.62, cost savings would be
	capture this 750 early-detected patients, this would require a detection of at least 1,630 all new neutral.
	HIV infected individuals, based on the premise that late-detected patients represent 46% of all
	newly-detected individuals; assuming a detection rate of 2 per 1,000, after 815,000 completed
	considered. Furthermore, this study did not consider additional general physician visit's costs
	and educational marketing campaigns that would be needed to raise awareness among the
	riskier population to successfully conduct wider testing strategies in townships with higher HIV
	prevalence. In addition to, in Poland it is not a very common to have open discussion about
	sexual lifestyle with a general physician. Also, the stress caused by false HIV positive or
	negative test on a patient would be tremendous.

shift, reducing the national proportion of late diagnoses from approximately 42% to 29.4% in UK and 46% to 32.2% in Poland. This figure was chosen because 30% success might be viewed as the minimum plausible outcome for expanded testing program to be considered. tests, with the required maximum cost per test of £1.76 (9.26 PLN), cost savings would be neutral. If we assume a detection rate of 3 per 1,000, the cost per test could rise to a maximum of £2.64 (13.89 PLN) for cost savings to remain neutral. With the value of life years saved, cost of the test could rise to a maximum of £2.36 (12.39 PLN) and £3.54

(18.

59 PLN), respectively.

The cost per test in three different Polish settings ranged £5.71-6.28

[START_REF] Margaret | Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) Study[END_REF][START_REF]The UK Collaborative HIV Cohort Study (UK CHIC), the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE). Mortality of treated HIV-1 positive individuals according to viral subtype in Europe and Canada: collaborative cohort analysis[END_REF][START_REF] Murray | Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013[END_REF][START_REF] Wolbers | Pretreatment CD4 cell slope and progression to AIDS or death in HIV-infected patients initiating antiretroviral therapy-the CASCADE collaboration: a collaboration of 23 cohort studies[END_REF]

, thus additional investment would be needed for potential improvement in early HIV detection rate

[START_REF] Publiczny | Opieki Zdrowotnej Ministerstwa Spraw Wewnętrznych z Warmińsko -Mazurskim Centrum Onkologii w Olsztynie[END_REF][START_REF] Publiczny | Hospital of Infectious Diseases in Warsaw, Cennik centralnego laboratorium analitycznego[END_REF][START_REF]Wojewódzki zespół specjalistycznej opieki zdrowotnej, cennik badań laboratoryjnych[END_REF]

. However, in Poland with a current fixed annual reimbursement policy per capita for ambulatory care and HIV antiretroviral therapy, there are considerable patient out of pocket expenses which were not captured in this study, as only direct cost impact to NFZNFZ was In the London and Leicester pilots, 7-11 cases were found per 1,000 tests administered, while in Brighton the pilots found fewer than 2 new cases per 1,000 tests, which seems surprisingly low for such a high-prevalence locality. Thus, if we assume a detection rate of 3 per 1,000, the cost per test could rise to a maximum of £6.93 for cost savings to remain neutral. With the value of life years saved, cost of the test could rise to a maximum of £6.20 and £9.29, respectively. Increase in number of HIV tests performed would probably lower the cost of actual HIV test, which would in return further add value towards cost neutral HIV testing in low and middle-prevalence settings. However, this is valid only under the assumption that HIV tests will not present any false negative or false positive results. Further limitation of this UK study includes no consideration for educational marketing campaigns and additional general

  The cost inputs were derived from the most comprehensive source available in the UK: the National Prospective Monitoring System, which has been recording the care provided to HIV patients at 15 participating hospitals since 1996. The most recent UK cost data are from 2008, which were adjusted for inflation to 2013 costs. In the absence of costing based on late or early detection in Poland, ratio based on UK resource use between the two groups was further applied on the average 2013 cost of treatment components (inpatient,

	outpatient cost) in Poland to derive total cost of late or early detection in treatment-naive or
	treatment-experienced patient (55). Further cost adjustment was made due to Polish NFZNFZ
	annual reimbursement cap per capita for ambulatory care and antiretroviral drugs which are
	purchased using tender process. We used 2013 average PLN / £ (GBP) currency exchange
	rate of 5.25, however currency exchange rate is subject to fluctuation that may impact the

results. As such, GBP currency was calculated based on actual PLN cost. In the absence of detection rate by CD4 cell count in Poland, UK rate was adjusted based on the percentage difference of newly-detected AIDS cases (Poland 9.3% vs UK 5.3%), which is a very conservative estimate of 46% vs 42% reported as late-detected HIV patients in Poland vs. UK, respectively. The rate of onward HIV transmission per HIV positive individual of 2.773% is a UK national average

Table I . Survival data by stage of presentation

 I

	A-Poland
		Age group: 15-49	Age group: 50+
	Year	S(t) Early	S(t) Late	S(t) Early	S(t) Late
	1	100.00%	100.00%	100.00%	100.00%
	2	99.61%	97.53%	99.17%	94.07%
	3	99.21%	95.12%	98.36%	88.28%
	4	98.82%	92.77%	97.57%	82.64%
	5	98.43%	90.48%	96.80%	77.15%
	B -UK
		Age group: 15-49	Age group: 50+
	Year	S(t) Early	S(t) Late	S(t) Early	S(t) Late
	1	100.00%	100.00%	100.00%	100.00%
	2	99.65%	97.73%	99.24%	94.55%
	3	99.31%	95.51%	98.49%	89.22%
	4	98.97%	93.34%	97.76%	84.02%
	5	98.62%	91.22%	97.05%	78.94%

Table II Annual costs by category according to early versus late HIV diagnosis (Poland, 2013) A Treatment costs in year 1 by diagnosis category

 II

	Cost category	Early detection	Late detection	Difference
	Mean inpatient care	276.05 zl.	2,484.41 zl. 2,208.36 zl.
	Mean outpatient care	2,701.28 zl.	3,177.98 zl.	476.70 zl.
	Mean day patient costs*	0.00 zl.	0.00 zl.	0.00 zl.
	Average annual ART costs	1,050.00 zl.	3,496.50 zl. 2,446.50 zl.
	Other drug costs	631.05 zl.	1,786.05 zl. 1,155.00 zl.
	Tests & procedures	66.62 zl.	95.24 zl.	28.61 zl.
	Total	4,725.00 zl.	11,040.17 zl. 6,315.17 zl.
	* Polish system encompasses dayward clinics (day patient cost) under the outpatient care.
	ART -Antiretroviral Therapy
	B Treatment costs from year 2 onwards by diagnosis category
	Cost category	Early detection	Late detection	Difference
	Mean inpatient care	1,380.23 zl.	2,760.45 zl. 1,380.23 zl.
	Mean outpatient care	3,177.98 zl.	3,177.98 zl.	0.00 zl.
	Mean day patient costs*	0.00 zl.	0.00 zl.	0.00 zl.
	Average annual cART costs	2,625.00 zl.	3,496.50 zl.	871.50 zl.
	Other drug costs	948.68 zl.	1,918.61 zl.	969.94 zl.
	Tests & procedures	78.49 zl.	99.23 zl.	20.74 zl.
	Total	8,210.37 zl.	11,452.77 zl. 3,242.40 zl.
	* Polish system encompasses dayward clinics (day patient cost) under the outpatient care.
	cART -Combination Antiretroviral Therapy

Table III . Annual costs by category according to early versus late HIV diagnosis (UK, 2013) A Treatment costs in year 1 by diagnosis category

 III

	Cost category	Early detection Late detection	Difference
	Mean inpatient care	£156.89	£1,056.66	£899.77
	Mean outpatient care	£470.28	£629.07	£158.79
	Mean day patient costs	£126.75	£238.13	£111.38
	Average annual cART costs	£200.00	£4,491.74	£4,291.74
	Other drug costs	£968.29	£2,299.04	£1,330.74
	Tests & procedures	£345.23	£575.14	£229.90
	Total	£2,267.44	£9,289.78	£7,022.34
	cART -Combination Antiretroviral Therapy
	B Treatment costs from year 2 onwards by diagnosis category
	Cost category	Early detection	Late detection	Difference
	Mean inpatient care	£528.33	£1,125.60	£597.27
	Mean outpatient care	£538.35	£595.74	£57.39
	Mean day patient costs	£253.49	£380.24	£126.75
	Average annual cART
	costs	£4,617.55	£4,491.74	-£125.81
	Other drug costs	£1,476.03	£2,406.88	£930.85
	Tests & procedures	£432.85	£593.86	£161.00
	Total	£7,846.60	£9,594.06	£1,747.46
	cART -Combination Antiretroviral Therapy

Table IV . Life Expectancy in HIV vs. general populationTable V .

 IVV Total cumulative annual cost: adjusted for HIV spread, survival and

	distribution of detection
	Panel A -UK
	Panel B Poland

Table VI :

 VI UK (All LHB), UK -Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

	UK (All LHB):
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other
		Inpatient	Outpatient		cART	drug		Total
		care	care	Dayward	costs	costs	Test +	savings per
		setting	setting	setting	savings	savings	procedures	annum
	Year
	1	693,830	122,450	85,889		3,463,679	1,026,166	177,285	5,569,298
	2	1,107,043	151,001	173,449 -286,914	1,403,709	239,210	2,787,498
	3	1,480,214	167,186	249,924 -569,911	2,057,555	345,129	3,730,097
	4	1,816,239	172,172	316,178 -946,305	2,679,718	441,968	4,479,969
	5	2,117,788	167,029	373,015	-	1,416,450	3,270,542	529,775	5,041,699
							Total Savings:	21,608,562
	Table VII: Wales (All LHB), UK -Total Annual Cost Savings due to 30-percent relative shift
	from Late to Early Detection

Wales (All LHB): Annual net cost savings from 30% relative shift to early HIV detection Inpatient care setting Outpatient care setting Dayward setting

					Annual	Other		Total
					cART	drug		savings
					costs	costs	Test +	per
					savings	savings	procedures	annum
	Year
	1	18,092	3,193	2,240	90,315	26,757	4,623	145,219
	2	28,866	3,937	4,523	-7,481	36,602	6,237	72,684
	3	38,596	4,359	6,517	-14,860	53,650	8,999	97,262
	4	47,358	4,489	8,244	-24,675	69,873	11,524	116,815
	5	55,221	4,355	9,726	-36,934	85,279	13,814	131,462
						Total Savings:	563,440

Table VIII :

 VIII Northern Ireland (All LHB) -Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

	Northern Ireland (All LHB):
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	Test +	Total
		care	t care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings	s	per annum
	Yea
	r
	1	8.823	1.557	1.092	44.045	13.049	2.254	70.820
	2	14.077	1.920	2.206	-3.648	17.850	3.042	35.446
	3	18.823	2.126	3.178	-7.247	26.164	4.389	47.432
	4	23.096	2.189	4.021	-12.033	34.076	5.620	56.968
	5	26.930	2.124	4.743	-18.012	41.589	6.737	64.111
						Total Savings:	274.778
	Table IX: Scotland (All LHB) -Total Annual Cost Savings due to 30-percent relative shift from
	Late to Early Detection

Scotland (All LHB): Annual net cost savings from 30% relative shift to early HIV detection

					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	Test +	Total
		care	t care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings	s	per annum
	Yea
	r
	1	30.261	5.341	3.746	151.065	44.755	7.732	242.899
	2	48.283	6.586	7.565	-12.513	61.221	10.433	121.574
	3	64.558	7.292	10.900 -24.856	89.738	15.052	162.684
	4	79.213	7.509	13.790 -41.272	116.873	19.276	195.389
	5	92.365	7.285	16.269 -61.777	142.641	23.106	219.889
						Total Savings:	942.435

Table X :

 X England (All LHB) -Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

	England (All LHB):
	Annual net cost savings from 30% relative shift to early HIV detection
							Annual	Other
		Inpatient	Outpatie	Daywar	cART	drug	Test +	Total
		care	nt care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings	s	per annum
	Yea
	r
	1		681.035	120.192		84.305	7	3.399.80	3	1.007.24	174.015	5.466.598
	2	9	1.086.62	148.216	1	170.25	-281.623	4	1.377.82	234.799	2.736.095
	3	8	1.452.91	164.103	6	245.31	-559.402	3	2.019.61	338.765	3.661.313
	4	7	1.782.74	168.997	7	310.34	-928.855	3	2.630.30	433.818	4.397.357
							-
	5		2.078.73			366.13		1.390.33		3.210.23
		5		163.949	7		0		2		520.005	4.948.728
												21.210.09
									Total Savings:	2

Table XI :

 XI England -Derbyshire And Nottinghamshire Area Team -Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

England -Derbyshire And Nottinghamshire Area Team: Annual net cost savings from 30% relative shift to early HIV detection

					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	Test +	Total
		care	t care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings	s	per annum
	Yea
	r
	1	32.797	5.788	4.060	163.728	48.507	8.380	263.261
	2	52.330	7.138	8.199	-13.562	66.353	11.307	131.765
	3	69.970	7.903	11.814 -26.940	97.261	16.314	176.322
	4	85.854	8.139	14.946 -44.732	126.670	20.892	211.768
	5	100.108	7.895	17.632 -66.956	154.599	25.042	238.321
						Total Savings:	1.021.437

Table XII :

 XII England -Leicestershire And Lincolnshire Area Team: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

England -Leicestershire And Lincolnshire Area Team: Annual net cost savings from 30% relative shift to early HIV detection

					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	Test +	Total
		care	t care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings	s	per annum
	Yea
	r
	1	32.952	5.815	4.079	164.499	48.735	8.420	264.500
	2	52.576	7.171	8.238	-13.626	66.666	11.361	132.385
	3	70.299	7.940	11.870 -27.067	97.719	16.391	177.152
	4	86.258	8.177	15.016 -44.942	127.267	20.990	212.765
	5	100.579	7.933	17.715 -67.271	155.326	25.160	239.443
						Total Savings:	1.026.246

Table XIII :

 XIII England -East Anglia Area Team: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

	England -East Anglia Area Team:
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	Test +	Total
		care	t care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings	s	per annum
	Yea
	r
	1	32.771	5.784	4.057	163.595	48.468	8.373	263.047
	2	52.287	7.132	8.192	-13.551	66.300	11.298	131.658
	3	69.913	7.896	11.804 -26.918	97.182	16.301	176.179
	4	85.784	8.132	14.934 -44.696	126.568	20.875	211.596
	5	100.027	7.889	17.618 -66.901	154.473	25.022	238.128
						Total Savings:	1.020.609

Table XIV :

 XIV England -Hertfordshire And The South Midlands Area Team: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

England -Hertfordshire And The South Midlands Area Team: Annual net cost savings from 30% relative shift to early HIV detection

					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	Test +	Total
		care	t care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings	s	per annum
	Yea
	r
	1	32.694	5.770	4.047	163.214	48.355	8.354	262.435
	2	52.166	7.115	8.173	-13.520	66.145	11.272	131.352
	3	69.750	7.878	11.777 -26.855	96.955	16.263	175.768
	4	85.584	8.113	14.899 -44.591	126.273	20.826	211.104
	5	99.794	7.871	17.577 -66.745	154.113	24.964	237.573
						Total Savings:	1.018.231

Table XV :

 XV England -Essex Area Team: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

	England -Essex Area Team:
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	Test +	Total
		care	t care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings	s	per annum
	Yea
	r
	1	32.925	5.811	4.076	164.366	48.696	8.413	264.286
	2	52.534	7.166	8.231	-13.615	66.612	11.352	132.278
	3	70.242	7.934	11.860 -27.045	97.640	16.378	177.009
	4	86.188	8.170	15.004 -44.906	127.164	20.973	212.593
	5	100.498	7.926	17.701 -67.216	155.201	25.140	239.250
						Total Savings:	1.025.416

Table XVI :

 XVI England -London North East And Central: Total Annual Cost Savings due to 30percent relative shift from Late to Early Detection

	England -London North East And Central:
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	Test +	Total
		care	t care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings	s	per annum
	Yea
	r
	1	33.009	5.826	4.086	164.787	48.821	8.434	264.963
	2	52.668	7.184	8.252	-13.650	66.782	11.381	132.617
	3	70.422	7.954	11.890 -27.114	97.890	16.420	177.462
	4	86.409	8.191	15.042 -45.021	127.489	21.027	213.137
	5	100.755	7.947	17.746 -67.389	155.598	25.204	239.862
						Total Savings:	1.028.041

Table XVII :

 XVII England -London South: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

	England -London South:
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	Test +	Total
		care	t care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings	s	per annum
	Yea
	r
	1	32.815	5.791	4.062	163.819	48.534	8.385	263.407
	2	52.359	7.142	8.203	-13.570	66.390	11.314	131.838
	3	70.008	7.907	11.820 -26.955	97.315	16.323	176.419
	4	85.901	8.143	14.954 -44.757	126.740	20.903	211.885
	5	100.163	7.900	17.642 -66.993	154.684	25.056	238.453
						Total Savings:	1.022.003

Table XVIII :

 XVIII England -London North West: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

	England -London North West:
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	Test +	Total
		care	t care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings	s	per annum
	Yea
	r
	1	32.954	5.816	4.079	164.509	48.738	8.420	264.517
	2	52.580	7.172	8.238	-13.627	66.670	11.361	132.394
	3	70.304	7.941	11.870 -27.068	97.725	16.392	177.163
	4	86.263	8.177	15.017 -44.945	127.275	20.992	212.779
	5	100.586	7.933	17.717 -67.275	155.336	25.162	239.458
						Total Savings:	1.026.311

Table XIX :

 XIX England -Devon, Cornwall And Isles Of Scilly Area Team: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

England -Devon, Cornwall And Isles Of Scilly Area Team: Annual net cost savings from 30% relative shift to early HIV detection

					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	Test +	Total
		care	t care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings	s	per annum
	Yea
	r
	1	32.757	5.781	4.055	163.528	48.448	8.370	262.939
	2	52.266	7.129	8.189	-13.546	66.272	11.294	131.604
	3	69.884	7.893	11.800 -26.907	97.142	16.294	176.107
	4	85.749	8.129	14.927 -44.677	126.516	20.866	211.510
	5	99.986	7.886	17.611 -66.874	154.410	25.012	238.030
						Total Savings:	1.020.190

Table XX :

 XX England Cumbria, Northumberland, Tyne And Wear Area Team: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

England -Cumbria, Northumberland, Tyne And Wear Area Team: Annual net cost savings from 30% relative shift to early HIV detection

					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	Test +	Total
		care	t care	d	costs	costs		savings
		setting	setting	setting	savings	savings	s	per annum
	Yea
	r
	1	32.936	5.813	4.077	164.419	48.712	8.416	264.372
	2	52.551	7.168	8.234	-13.620	66.633	11.355	132.321
	3	70.265	7.936	11.864 -27.053	97.671	16.383	177.066
	4	86.216	8.173	15.009 -44.921	127.205	20.980	212.662
	5	100.531	7.929	17.707 -67.238	155.251	25.148	239.327
						Total Savings:	1.025.750

Table XXI :

 XXI England Lancashire Area Team: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

	England Lancashire Area Team:
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	Test +	Total
		care	t care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings	s	per annum
	Yea
	r
	1	32.882	5.803	4.070	164.148	48.631	8.402	263.936
	2	52.464	7.156	8.220	-13.597	66.524	11.336	132.103
	3	70.149	7.923	11.844 -27.009	97.510	16.356	176.774
	4	86.074	8.159	14.984 -44.847	126.995	20.945	212.312
	5	100.365	7.916	17.678 -67.127	154.995	25.107	238.933
						Total Savings:	1.024.058

Table XXII :

 XXII England Greater Manchester Area Team: Total Annual Cost Savings due to 30percent relative shift from Late to Early Detection

	England Greater Manchester Area Team:
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	Test +	Total
		care	t care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings	s	per annum
	Yea
	r
	1	32.944	5.814	4.078	164.458	48.723	8.418	264.435
	2	52.563	7.170	8.236	-13.623	66.649	11.358	132.353
	3	70.282	7.938	11.867 -27.060	97.695	16.387	177.108
	4	86.237	8.175	15.012 -44.931	127.235	20.985	212.713
	5	100.554	7.931	17.711 -67.254	155.288	25.154	239.384
						Total Savings:	1.025.993

Table XXIII :

 XXIII England -Cheshire, Warrington And Wirral Area Team: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

England Cheshire, Warrington And Wirral Area Team: Annual net cost savings from 30% relative shift to early HIV detection

					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	Test +	Total
		care	t care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings	s	per annum
	Yea
	r
	1	32.888	5.804	4.071	164.179	48.640	8.403	263.985
	2	52.474	7.157	8.222	-13.600	66.536	11.339	132.128
	3	70.162	7.925	11.846 -27.014	97.528	16.359	176.807
	4	86.090	8.161	14.987 -44.855	127.019	20.949	212.351
	5	100.383	7.917	17.681 -67.140	155.024	25.111	238.977
						Total Savings:	1.024.248

Table XXIV :

 XXIV England Merseyside Area Team: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

	England Merseyside Area Team:
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	Test +	Total
		care	t care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings	s	per annum
	Yea
	r
	1	32.813	5.791	4.062	163.807	48.530	8.384	263.387
	2	52.355	7.141	8.203	-13.569	66.385	11.313	131.828
	3	70.003	7.907	11.820 -26.953	97.307	16.322	176.406
	4	85.895	8.142	14.953 -44.753	126.731	20.902	211.870
	5	100.156	7.899	17.641 -66.988	154.673	25.054	238.435
						Total Savings:	1.021.926

Table XXV :

 XXV England Kent And Medway Area Team: Total Annual Cost Savings due to 30percent relative shift from Late to Early Detection

England Kent And Medway Area Team: Annual net cost savings from 30% relative shift to early HIV detection

					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	Test +	Total
		care	t care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings	s	per
	Yea
	r
	1	32.646	5.762	4.041	162.973	48.283	8.342	262.047
	2	52.089	7.105	8.161	-13.500	66.047	11.255	131.158
	3	69.647	7.866	11.759 -26.816	96.812	16.239	175.509
	4	85.458	8.101	14.877 -44.526	126.086	20.796	210.792
	5	99.646	7.859	17.551 -66.647	153.886	24.927	237.222
						Total Savings:	1.016.727

Table XXVI :

 XXVI England Bath, Gloucestershire, Swindon And Wiltshire Area Team: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

England Bath, Gloucestershire, Swindon And Wiltshire Area Team: Annual net cost savings from 30% relative shift to early HIV detection

					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	Test +	Total
		care	t care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings		per annum
	Yea
	r
	1	32.961	5.817	4.080	164.546	48.749	8.422	264.576
	2	52.591	7.173	8.240	-13.630	66.685	11.364	132.424
	3	70.319	7.942	11.873 -27.074	97.747	16.396	177.203
	4	86.283	8.179	15.020 -44.955	127.303	20.996	212.827
	5	100.608	7.935	17.721 -67.290	155.371	25.168	239.512
						Total Savings:	1.026.542

Table XXVII :

 XXVII England Bristol, North Somerset, Somerset And South Gloucestershire Area Team: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

England Bristol, North Somerset, Somerset And South Gloucestershire Area Team: Annual net cost savings from 30% relative shift to early HIV detection

					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	Test +	Total
		care	t care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings	s	per annum
	Yea
	r
	1	32.816	5.792	4.062	163.822	48.535	8.385	263.411
	2	52.360	7.142	8.204	-13.570	66.391	11.314	131.840
	3	70.010	7.907	11.821 -26.955	97.316	16.324	176.423
	4	85.903	8.143	14.954 -44.757	126.743	20.904	211.889
	5	100.165	7.900	17.643 -66.994	154.687	25.057	238.458
						Total Savings:	1.022.021

Table XXVIII :

 XXVIII England Birmingham And The Black Country Area Team: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

England Birmingham And The Black Country Area Team: Annual net cost savings from 30% relative shift to early HIV detection

					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	+	Total
		care	t care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings	s	per annum
	Yea
	r
	1	32.847	5.797	4.066	163.978	48.581	8.393	263.663
	2	52.410	7.149	8.211	-13.583	66.455	11.325	131.966
	3	70.077	7.915	11.832 -26.981	97.409	16.339	176.591
	4	85.985	8.151	14.969 -44.800	126.864	20.924	212.092
	5	100.261	7.908	17.659 -67.058	154.835	25.081	238.685
						Total Savings:	1.022.998

Table XXIX :

 XXIX England Arden, Herefordshire And Worcestershire Area Team: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

England Birmingham And The Black Country Area Team: Annual net cost savings from 30% relative shift to early HIV detection

					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	Test +	Total
		care	t care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings	s	per annum
	Yea
	r
	1	32.951	5.815	4.079	164.494	48.734	8.419	264.492
	2	52.575	7.171	8.237	-13.626	66.664	11.360	132.381
	3	70.297	7.940	11.869 -27.066	97.716	16.391	177.147
	4	86.255	8.177	15.016 -44.941	127.263	20.990	212.759
	5	100.576	7.932	17.715 -67.269	155.322	25.160	239.436
						Total Savings:	1.026.215

Table XXX :

 XXX England Shropshire And Staffordshire Area Team: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

England -Shropshire And Staffordshire Area Team: Annual net cost savings from 30% relative shift to early HIV detection

					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	Test +	Total
		care	t care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings	s	per annum
	Yea
	r
	1	32.930	5.812	4.076	164.388	48.702	8.414	264.322
	2	52.541	7.167	8.232	-13.617	66.621	11.353	132.296
	3	70.252	7.935	11.862 -27.048	97.653	16.380	177.033
	4	86.200	8.171	15.006 -44.912	127.181	20.976	212.622
	5	100.512	7.927	17.704 -67.226	155.222	25.143	239.282
						Total Savings:	1.025.556

Table XXXI :

 XXXI England North Yorkshire And Humber Area Team: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

England North Yorkshire And Humber Area Team: Annual net cost savings from 30% relative shift to early HIV detection

					Annual	Other
		Inpatient	Outpatien	Daywar	cART	drug	Test +	Total
		care	t care	d	costs	costs	procedure	savings
		setting	setting	setting	savings	savings	s	per annum
	Yea
	r
	1	33.067	5.836	4.093	165.074	48.906	8.449	265.425
	2	52.760	7.196	8.266	-13.674	66.899	11.400	132.848
	3	70.545	7.968	11.911 -27.161	98.060	16.448	177.771
	4	86.559	8.205	15.069 -45.100	127.712	21.064	213.509
	5	100.931	7.960	17.777 -67.506	155.870	25.248	240.280
						Total Savings:	1.029.834

Table XXXII :

 XXXII Poland, Dolnoslaskie: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

	Panel A -Polish Zloty
	Poland, Dolnoslaskie:
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other		Total
		Inpatient	Outpatient		cART	drug		savings
		care	care	Dayward	costs	costs	Test +	per
		setting	setting	setting	savings	savings	procedures	annum
	Year
	1	40.942 z	8.838 z	0 z	45.357 z	21.413 z	530 z	117.081 z
	2	63.945 z	7.319 z	0 z	31.190 z	35.561 z	735 z	138.749 z
	3	84.795 z	4.617 z	0 z	45.097 z	52.735 z	1.052 z	188.295 z
	4	103.649 z	860 z	0 z	57.891 z	69.517 z	1.336 z	233.254 z
	5	120.653 z	-3.835 z	0 z	69.583 z	85.920 z	1.587 z	273.909 z
								951.288
						Total Savings:	z
	Panel B GBP

Poland, Dolnoslaskie: Annual net cost savings from 30% relative shift to early HIV detection Inpatient care setting Outpatient care setting Dayward setting Annual cART costs savings

						Other		Total
						drug		savings
						costs	Test +	per
						savings	procedures	annum
	Year
	1	7.799	1.683	0	8.639	4.079	101	22.301
	2	12.180	1.394	0	5.941	6.773	140	26.428
	3	16.151	879	0	8.590	10.045	200	35.866
	4	19.743	164	0	11.027	13.241	255	44.429
	5	22.981	-730	0	13.254	16.366	302	52.173
						Total Savings:	181.198

Table XXXIII :

 XXXIII Poland, Kujawsko-pomorskie: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection Panel A -Polish Zloty

	Poland, Kujawsko-pomorskie:
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other		Total
		Inpatient	Outpatient		cART	drug		savings
		care	care	Dayward	costs	costs	Test +	per
		setting	setting	setting	savings	savings	procedures	annum
	Year
	1	11.383 z	2.457 z	0 z	z 12.611	5.954 z 147 z	32.552 z
	2	17.779 z	2.035 z	0 z	8.672 z 9.887 z 204 z	38.576 z
	3	23.575 z	1.284 z	0 z	z 12.538	z 14.662	293 z	52.352 z
	4	28.818 z	239 z	0 z	z 16.095	z 19.328	372 z	64.852 z
	5	33.545 z	-1.066 z	0 z	z 19.346	z 23.888	441 z	76.155 z
								264.486
						Total Savings:	z
	Panel B GBP
	Poland, Kujawsko-

pomorskie: Annual net cost savings from 30% relative shift to early HIV detection Inpatient care setting Outpatient care setting Dayward setting Annual cART costs savings Other drug costs savings Test + procedures

								Total
								savings
								per
								annum
	Year
	1	2.168	468	0	2.402	1.134	28	6.200
	2	3.386	388	0	1.652	1.883	39	7.348
	3	4.491	245	0	2.388	2.793	56	9.972
	4	5.489	46	0	3.066	3.681	71	12.353
	5	6.390	-203	0	3.685	4.550	84	14.506
						Total Savings:	50.378

Table XXXIV :

 XXXIV Poland, Lubelskie: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

	Panel A -Polish Zloty
	Poland, Lubelskie:
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other		Total
		Inpatient	Outpatient		cART	drug		savings
		care	care	Dayward	costs	costs	Test +	per
		setting	setting	setting	savings	savings	procedures	annum
	Year
	1	13.180 z	2.845 z	0 z	14.602 z	6.894 z 171 z	37.692 z
	2	20.586 z	2.356 z	0 z	10.041 z	11.448 z	237 z	44.667 z
	3	27.298 z	1.486 z	0 z	14.518 z	16.977 z	339 z	60.618 z
	4	33.368 z	277 z	0 z	18.637 z	22.380 z	430 z	75.091 z
	5	38.842 z	z	0 z	22.401 z	27.660 z	511 z	88.179 z
								306.247
						Total Savings:	z
	Panel B GBP

Poland, Lubelskie: Annual net cost savings from 30% relative shift to early HIV detection Inpatient care setting Outpatient care setting Dayward setting Annual cART costs savings Other drug costs savings Test + procedures

								Total
								savings
								per
								annum
	Year
	1	2.511	542	0	2.781	1.313	33	7.179
	2	3.921	449	0	1.913	2.181	45	8.508
	3	5.200	283	0	2.765	3.234	65	11.546
	4	6.356	53	0	3.550	4.263	82	14.303
	5	7.398	-235	0	4.267	5.269	97	16.796
						Total Savings:	58.333

Table XXXV :

 XXXV Poland, Lubuskie: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

	Panel A -Polish Zloty
	Poland, Lubuskie:
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other		Total
		Inpatient	Outpatient		cART	drug		savings
		care	care	Dayward	costs	costs	Test +	per
		setting	setting	setting	savings	savings	procedures	annum
	Year
	1	7.189 z	1.552 z	0 z	7.965 z 3.760 z 93 z	20.559 z
	2	11.229 z	1.285 z	0 z	5.477 z 6.244 z 129 z	24.364 z
	3	14.890 z	811 z	0 z	7.919 z 9.260 z 185 z	33.064 z
	4	18.201 z	151 z	0 z	10.165 z	12.207 z	235 z	40.959 z
	5	21.186 z	-673 z	0 z	12.219 z	15.087 z	279 z	48.098 z
								167.044
						Total Savings:	z
	Panel B GBP
	Poland, Lubuskie:

Annual net cost savings from 30% relative shift to early HIV detection Inpatient care setting Outpatient care setting Dayward setting Annual cART costs savings Other drug costs savings Test + procedures

								Total
								savings
								per
								annum
	Year
	1	1.369	296	0	1.517	716	18	3.916
	2	2.139	245	0	1.043	1.189	25	4.641
	3	2.836	154	0	1.508	1.764	35	6.298
	4	3.467	29	0	1.936	2.325	45	7.802
	5	4.035	-128	0	2.327	2.874	53	9.161
						Total Savings:	31.818

Table XXXVI :

 XXXVI Poland, Lodzkie: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

	Panel A -Polish Zloty
	Poland, Lodzkie:
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other		Total
		Inpatient	Outpatient		cART	drug		savings
		care	care	Dayward	costs	costs	Test +	per
		setting	setting	setting	savings	savings	procedures	annum
	Year
	1	11.683 z	2.522 z	0 z	12.943 z	6.110 z 151 z	33.409 z
	2	18.246 z	2.088 z	0 z	8.900 z	10.147 z	210 z	39.591 z
	3	24.196 z	1.317 z	0 z	12.868 z	15.048 z	300 z	53.729 z
	4	29.576 z	246 z	0 z	16.519 z	19.836 z	381 z	66.558 z
	5	34.428 z	-1.094 z	0 z	19.855 z	24.517 z	453 z	78.159 z
								271.447
						Total Savings:	z
	Panel B GBP

Poland, Lodzkie: Annual net cost savings from 30% relative shift to early HIV detection Inpatient care setting Outpatient care setting Dayward setting Annual cART costs savings Other drug costs savings Test + procedures

								Total
								savings
								per
								annum
	Year
	1	2.225	480	0	2.465	1.164	29	6.364
	2	3.476	398	0	1.695	1.933	40	7.541
	3	4.609	251	0	2.451	2.866	57	10.234
	4	5.634	47	0	3.146	3.778	73	12.678
	5	6.558	-208	0	3.782	4.670	86	14.887
						Total Savings:	51.704

Table XXXVII :

 XXXVII Poland, Malopolskie: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

	Panel A -Polish Zloty
	Poland, Malopolskie:
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other		Total
		Inpatient	Outpatient		cART	drug		savings
		care	care	Dayward	costs	costs	Test +	per
		setting	setting	setting	savings	savings	procedures	annum
	Year
	1	17.374 z	3.750 z	0 z	19.248 z	9.087 z 225 z	49.685 z
	2	27.136 z	3.106 z	0 z	13.236 z	15.091 z	312 z	58.880 z
	3	35.984 z	1.959 z	0 z	19.137 z	22.379 z	447 z	79.905 z
	4	43.985 z	365 z	0 z	24.567 z	29.500 z	567 z	98.984 z
	5	51.200 z	-1.627 z	0 z	29.528 z	36.461 z	673 z	116.236 z
								403.690
						Total Savings:	z
	Panel B GBP

Poland, Malopolskie: Annual net cost savings from 30% relative shift to early HIV detection Inpatient care setting Outpatient care setting Dayward setting Annual cART costs savings Other drug costs savings Test + procedures

								Total
								savings
								per
								annum
	Year
	1	3.309	714	0	3.666	1.731	43	9.464
	2	5.169	592	0	2.521	2.874	59	11.215
	3	6.854	373	0	3.645	4.263	85	15.220
	4	8.378	70	0	4.679	5.619	108	18.854
	5	9.752	-310	0	5.624	6.945	128	22.140
						Total Savings:	76.893

Table XXXVIII :

 XXXVIII Poland, Mazowieckie: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

	Panel A -Polish Zloty
	Poland, Mazowieckie:
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other		Total
		Inpatient	Outpatient		cART	drug		savings
		care	care	Dayward	costs	costs	Test +	per
		setting	setting	setting	savings	savings	procedures	annum
	Year
	1	68.299 z	14.743 z	0 z	z 75.664	z 35.721	885 z	195.312 z
	2	z 106.671	12.209 z	0 z	z 52.030	z 59.322	1.227 z	231.458 z
	3	z 141.453	7.702 z	0 z	z 75.229	z 87.971	1.756 z	314.110 z
	4	z 172.906	1.435 z	0 z	z 96.572	z 115.967	2.229 z	389.109 z
	5	z 201.270	-6.397 z	0 z	z 116.077	z 143.330	2.647 z	456.929 z
								1.586.918
						Total Savings:	z
	Panel B GBP

Poland, Mazowieckie: Annual net cost savings from 30% relative shift to early HIV detection Inpatient care setting Outpatient care setting Dayward setting Annual cART costs savings Other drug costs savings Test + procedures

								Total
								savings
								per
								annum
	Year
	1	13.009	2.808	0	14.412	6.804	169	37.202
	2	20.318	2.325	0	9.910	11.299	234	44.087
	3	26.943	1.467	0	14.329	16.756	334	59.831
	4	32.934	273	0	18.395	22.089	425	74.116
	5	38.337	-1.218	0	22.110	27.301	504	87.034
						Total Savings:	302.270

Table XXXIX :

 XXXIX Poland, Opolskie: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

	Panel A -Polish Zloty
	Poland, Opolskie:
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other		Total
		Inpatient	Outpatient		cART	drug		savings
		care	care	Dayward	costs	costs	Test +	per
		setting	setting	setting	savings	savings	procedures	annum
	Year
	1	6.590 z	1.423 z	0 z	7.301 z 3.447 z 85 z	18.846 z
	2	10.293 z	1.178 z	0 z	5.020 z 5.724 z 118 z	22.334 z
	3	13.649 z	743 z	0 z	7.259 z 8.488 z 169 z	30.309 z
	4	16.684 z	138 z	0 z	9.318 z	11.190 z	215 z	37.546 z
	5	19.421 z	-617 z	0 z	11.200 z	13.830 z	255 z	44.090 z
								153.124
						Total Savings:	z
	Panel B GBP
	Poland, Opolskie:

Annual net cost savings from 30% relative shift to early HIV detection Inpatient care setting Outpatient care setting Dayward setting Annual cART costs savings Other drug costs savings Test + procedures

								Total
								savings
								per
								annum
	Year
	1	1.255	271	0	1.391	657	16	3.590
	2	1.961	224	0	956	1.090	23	4.254
	3	2.600	142	0	1.383	1.617	32	5.773
	4	3.178	26	0	1.775	2.131	41	7.152
	5	3.699	-118	0	2.133	2.634	49	8.398
						Total Savings:	29.166

Table XL :

 XL Poland, Podkarpackie: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

	Panel A -Polish Zloty
	Poland, Podkarpackie:
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other		Total
		Inpatient	Outpatient		cART	drug		savings
		care	care	Dayward	costs	costs	Test +	per
		setting	setting	setting	savings	savings	procedures	annum
	Year
	1	9.286 z	2.005 z	0 z	10.288 z	4.857 z 120 z	26.556 z
	2	14.504 z	1.660 z	0 z	7.074 z 8.066 z 167 z	31.470 z
	3	19.233 z	1.047 z	0 z	10.229 z	11.961 z	239 z	42.708 z
	4	23.509 z	195 z	0 z	13.130 z	15.767 z	303 z	52.905 z
	5	27.366 z	-870 z	0 z	15.782 z	19.488 z	360 z	62.126 z
								215.765
						Total Savings:	z
	Panel B GBP

Poland, Podkarpackie: Annual net cost savings from 30% relative shift to early HIV detection Inpatient care setting Outpatient care setting Dayward setting Annual cART costs savings Other drug costs savings Test + procedures

								Total
								savings
								per
								annum
	Year
	1	1.769	382	0	1.960	925	23	5.058
	2	2.763	316	0	1.347	1.536	32	5.994
	3	3.663	199	0	1.948	2.278	45	8.135
	4	4.478	37	0	2.501	3.003	58	10.077
	5	5.213	-166	0	3.006	3.712	69	11.834
						Total Savings:	41.098

Table XLI :

 XLI Poland, Podlaskie: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

	Panel A -Polish Zloty
	Poland, Podlaskie:
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other		Total
		Inpatient	Outpatient		cART	drug		savings
		care	care	Dayward	costs	costs	Test +	per
		setting	setting	setting	savings	savings	procedures	annum
	Year
	1	5.092 z	1.099 z	0 z	5.642 z 2.663 z 66 z	14.563 z
	2	7.954 z	910 z	0 z	3.879 z 4.423 z 91 z	17.258 z
	3	10.547 z	574 z	0 z	5.609 z 6.559 z 131 z	23.421 z
	4	12.892 z	107 z	0 z	7.201 z 8.647 z 166 z	29.013 z
	5	15.007 z	-477 z	0 z	8.655 z	10.687 z	197 z	34.069 z
								118.323
						Total Savings:	z
	Panel B GBP
	Poland, Podlaskie:

Annual net cost savings from 30% relative shift to early HIV detection Inpatient care setting Outpatient care setting Dayward setting Annual cART costs savings Other drug costs savings Test + procedures

								Total
								savings
								per
								annum
	Year
	1	970	209	0	1.075	507	13	2.774
	2	1.515	173	0	739	842	17	3.287
	3	2.009	109	0	1.068	1.249	25	4.461
	4	2.456	20	0	1.372	1.647	32	5.526
	5	2.858	-91	0	1.649	2.036	38	6.489
						Total Savings:	22.538

Table XLII :

 XLII Poland, Pomorskie: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

	Panel A -Polish Zloty
	Poland, Pomorskie:
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other		Total
		Inpatient	Outpatient		cART	drug		savings
		care	care	Dayward	costs	costs	Test +	per
		setting	setting	setting	savings	savings	procedures	annum
	Year
	1	13.180 z	2.845 z	0 z	14.602 z	6.894 z 171 z	37.692 z
	2	20.586 z	2.356 z	0 z	10.041 z	11.448 z	237 z	44.667 z
	3	27.298 z	1.486 z	0 z	14.518 z	16.977 z	339 z	60.618 z
	4	33.368 z	277 z	0 z	18.637 z	22.380 z	430 z	75.091 z
	5	38.842 z	-1.234 z	0 z	22.401 z	27.660 z	511 z	88.179 z
								306.247
						Total Savings:	z
	Panel B GBP

Poland, Pomorskie: Annual net cost savings from 30% relative shift to early HIV detection Inpatient care setting Outpatient care setting Dayward setting Annual cART costs savings Other drug costs savings Test + procedures

	Poland,
								Total
								savings
								per
								annum
	Year
	1	2.511	542	0	2.781	1.313	33	7.179
	2	3.921	449	0	1.913	2.181	45	8.508
	3	5.200	283	0	2.765	3.234	65	11.546
	4	6.356	53	0	3.550	4.263	82	14.303
	5	7.398	-235	0	4.267	5.269	97	16.796
						Total Savings:	58.333
	Table XLIII: Poland, Slaskie: Total Annual Cost Savings due to 30-percent relative shift from
	Late to Early Detection
	Panel A -Polish Zloty

Slaskie: Annual net cost savings from 30% relative shift to early HIV detection

					Annual	Other		Total
		Inpatient	Outpatient		cART	drug		savings
		care	care	Dayward	costs	costs	Test +	per
		setting	setting	setting	savings	savings	procedures	annum
	Year
	1	36.845 z	7.953 z	0 z	40.819 z	19.271 z	477 z	105.366 z
	2	57.546 z	6.586 z	0 z	28.069 z	32.003 z	662 z	124.865 z
	3	76.310 z	4.155 z	0 z	40.584 z	47.458 z	947 z	169.454 z
	4	93.278 z	774 z	0 z	52.098 z	62.561 z	1.202 z	209.914 z
	5	108.580 z	-3.451 z	0 z	62.621 z	77.323 z	1.428 z	246.501 z
								856.101
						Total Savings:	z
	Panel B GBP
	Poland, Slaskie:

Annual net cost savings from 30% relative shift to early HIV detection Inpatient care setting Outpatient care setting Dayward setting

					Annual	Other		Total
					cART	drug		savings
					costs	costs	Test +	per
					savings	savings	procedures	annum
	Year
	1	7.018	1.515	0	7.775	3.671	91	20.070
	2	10.961	1.255	0	5.346	6.096	126	23.784
	3	14.535	791	0	7.730	9.040	180	32.277
	4	17.767	147	0	9.923	11.916	229	39.984
	5	20.682	-657	0	11.928	14.728	272	46.953
						Total Savings:	163.067

Table XLIV :

 XLIV Poland, Swietokrzyskie: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

	Poland, Swietokrzyskie:
	Panel A -Polish Zloty

Annual net cost savings from 30% relative shift to early HIV detection

					Annual	Other		Total
		Inpatient	Outpatient		cART	drug		savings
		care	care	Dayward	costs	costs	Test +	per
		setting	setting	setting	savings	savings	procedures	annum
	Year
	1	4.493 z	970 z	0 z	4.978 z 2.350 z 58 z	12.849 z
	2	7.018 z	803 z	0 z	3.423 z 3.903 z 81 z	15.227 z
	3	9.306 z	507 z	0 z	4.949 z 5.788 z 116 z	20.665 z
	4	11.375 z	94 z	0 z	6.353 z 7.629 z 147 z	25.599 z
	5	13.241 z	-421 z	0 z	7.637 z 9.430 z 174 z	30.061 z
								104.403
						Total Savings:	z
	Panel B GBP
	Poland, Swietokrzyskie:

Annual net cost savings from 30% relative shift to early HIV detection

					Annual	Other		Total
		Inpatient	Outpatient		cART	drug		savings
		care	care	Dayward	costs	costs	Test +	per
		setting	setting	setting	savings	savings	procedures	annum
	Year
	1	856	185	0	948	448	11	2.448
	2	1.337	153	0	652	743	15	2.900
	3	1.773	97	0	943	1.102	22	3.936
	4	2.167	18	0	1.210	1.453	28	4.876
	5	2.522	-80	0	1.455	1.796	33	5.726
						Total Savings:	19.886

Table XLV :

 XLV Poland, Warminsko-mazurskie: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

	Panel A -Polish Zloty
	Poland, Warminsko-mazurskie:
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other		Total
		Inpatient	Outpatient		cART	drug		savings
		care	care	Dayward	costs	costs	Test +	per
		setting	setting	setting	savings	savings	procedures	annum
	Year
	1	7.189 z	1.552 z	0 z	7.965 z 3.760 z 93 z	20.559 z
	2	11.229 z	1.285 z	0 z	5.477 z 6.244 z 129 z	24.364 z
	3	14.890 z	811 z	0 z	7.919 z 9.260 z 185 z	33.064 z
	4	18.201 z	151 z	0 z	10.165 z	12.207 z	235 z	40.959 z
	5	21.186 z	-673 z	0 z	12.219 z	15.087 z	279 z	48.098 z
						Total Savings:	167.044 z
	Panel B GBP
	Poland, Warminsko

-mazurskie: Annual net cost savings from 30% relative shift to early HIV detection Inpatient care setting Outpatient care setting Dayward setting Annual cART costs savings Other drug costs savings Test + procedures

								Total
								savings
								per
								annum
	Year
	1	1.369	296	0	1.517	716	18	3.916
	2	2.139	245	0	1.043	1.189	25	4.641
	3	2.836	154	0	1.508	1.764	35	6.298
	4	3.467	29	0	1.936	2.325	45	7.802
	5	4.035	-128	0	2.327	2.874	53	9.161
						Total Savings:	31.818

Table XLVI :

 XLVI Poland, Wielkoposkie: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection Panel A -Polish Zloty

	Poland, Wielkoposkie:
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other		Total
		Inpatient	Outpatient		cART	drug		savings
		care	care	Dayward	costs	costs	Test +	per
		setting	setting	setting	savings	savings	procedures	annum
	Year
	1	32.352 z	6.984 z	0 z	35.841 z	16.921 z	419 z	92.516 z
	2	50.528 z	5.783 z	0 z	24.646 z	28.100 z	581 z	109.638 z
	3	67.004 z	3.648 z	0 z	35.635 z	41.671 z	832 z	148.789 z
	4	81.903 z	680 z	0 z	45.745 z	54.932 z	1.056 z	184.315 z
	5	95.339 z	-3.030 z	0 z	54.984 z	67.893 z	1.254 z	216.440 z
								751.698
						Total Savings:	z
	Panel B GBP

Poland, Wielkoposkie: Annual net cost savings from 30% relative shift to early HIV detection Inpatient care setting Outpatient care setting Dayward setting Annual cART costs savings Other drug costs savings Test + procedures

								Total
								savings
								per
								annum
	Year
	1	6.162	1.330	0	6.827	3.223	80	17.622
	2	9.624	1.102	0	4.694	5.352	111	20.883
	3	12.763	695	0	6.788	7.937	158	28.341
	4	15.600	129	0	8.713	10.463	201	35.108
	5	18.160	-577	0	10.473	12.932	239	41.227
						Total Savings:	143.181

Table XLVII : Poland, Zachodniopomorskie: Total Annual Cost Savings due to 30-percent relative shift from Late to Early Detection

 XLVII

	Panel A -Polish Zloty
	Poland, Zachodniopomorskie:
	Annual net cost savings from 30% relative shift to early HIV detection
					Annual	Other		Total
		Inpatient	Outpatient		cART	drug		savings
		care	care	Dayward	costs	costs	Test +	per
		setting	setting	setting	savings	savings	procedures	annum
	Year
	1	12.847 z	2.773 z	0 z	14.232 z	6.719 z 166 z	36.737 z
	2	20.064 z	2.296 z	0 z	9.787 z	11.158 z	231 z	43.536 z
	3	26.607 z	1.449 z	0 z	14.150 z	16.547 z	330 z	59.083 z
	4	32.523 z	270 z	0 z	18.165 z	21.813 z	419 z	73.190 z
	5	37.858 z	-1.203 z	0 z	21.834 z	26.960 z	498 z	85.946 z
								298.492
						Total Savings:	z
	Panel B GBP

Poland, Zachodniopomorskie: Annual net cost savings from 30% relative shift to early HIV detection Inpatient care setting Outpatient care setting Dayward setting Annual cART costs savings Other drug costs savings Test + procedures

	Patients 0-49 age group: Early Detected
								Total
								savings
								per
								annum
	Year
	1	2.447	528	0	2.711	1.280	32	6.998
	2	3.822	437	0	1.864	2.125	44	8.293
	3	5.068	276	0	2.695	3.152	63	11.254
	4	6.195	51	0	3.460	4.155	80	13.941
	5	7.211	-229	0	4.159	5.135	95	16.371
						Total Savings:	56.856

Linear Regression: Poland, Patient age 0-49, early HIV detected.

	1	0.08333	0.11275	-0.02941	-1.42887	-1.90985	-2.555	0.0049	0.01427	-0.17933	-0.02956
	2	0.20238	0.22549	-0.02311	-1.02062	-1.51181	-1.70552	0.01961	0.0363	-0.2412	-0.02357
	3	0.32143	0.33824	-0.01681	-0.61237	-1.1135	-1.13645	0.04412	0.04544	-0.24415	-0.01758
	4	0.44048	0.45098	-0.0105	-0.20412	-0.70878	-0.68109	0.07843	0.03395	-0.1987	-0.0114
	5	0.55952	0.56373	-0.0042	0.20412	-0.29055	-0.27063	0.12255	0.00936	-0.10114	-0.00479
	6	0.67857	0.67647	0.0021	0.61237	0.14996	0.13906	0.17647	0.00383	0.06437	0.00255
	7	0.79762	0.78922	0.0084	1.02062	0.62447	0.59496	0.2402	0.0979	0.33452	0.01106
	8	0.91667	0.90196	0.01471	1.42887	1.14988	1.18206	0.31373	0.48	0.79922	0.02143
	Minimum	0.08333	0.11275	-0.02941	-1.42887	-1.90985	-2.555	0.0049	0.00383	-0.24415	-0.02956
	Maximum	0.91667	0.90196	0.01471	1.42887	1.14988	1.18206	0.31373	0.48	0.79922	0.02143
	Mean	0.5	0.50735	-0.00735	0.	-0.45127	-0.55408	0.125	0.09013	0.0292	-0.00648
	Regression Statistics
	R		0.9996
	R-Squared		0.99919
	Adjusted R-Squared	0.99919
	S		0.01732
	MSE		0.0021
	RMSE		0.04583
	PRESS		0.00248
	PRESS RMSE		0.0176
	Predicted R-Squared	0.99904
	N		8
	Median Ranks = 0.11275 * YEAR
	ANOVA
		d.f.	SS	MS	F	p-value
	Regression	1.	2.59314	2.59314	8,640.33333	4.39364E-12
	Residual	7.	0.0021	0.0003
	Total	8.	2.59524
		Coefficient	Standard Error	LCL	UCL	t Stat	p-value	H0 (5%)	VIF	TOL
	Intercept	0
	YEAR	0.11275	0.00121	0.10988	0.11561	92.95339	4.39364E-12	rejected	**	**
	T (5%)	2.36462
	LCL -Lower limit of the 95% confidence interval
	UCL -Upper limit of the 95% confidence interval
	** -Requires Pro version, please upgrade.
	Residuals
	Observation	Median Ranks	Predicted Y	Residual	Standardized [Excel]	Studentized	Deleted t	Leverage	Cook's D	DFIT	PRESS
					277

Scatter Diagram (Predicted Y, Median Ranks vs. YEAR ) Residuals vs YEAR

	5 Regression Statistics 0.55952	0.56373		-0.0042		0.20412	-0.29055	-0.27063	0.12255	0.00936	-0.10114	-0.00479
	6 Patients 50+ age group: Early Detected 0.67857 0.67647 0.0021 R 0.9996	0.61237	0.14996	0.13906	0.17647	0.00383	0.06437	0.00255
	7 R-Squared	0.79762	0.78922 0.99919	0.0084		1.02062	0.62447	0.59496	0.2402	0.0979	0.33452	0.01106
	8 Linear Regression: Poland, Patient age 50+, early HIV detected. 0.91667 0.90196 0.01471 1.42887 1.14988 1.18206 Adjusted R-Squared 0.99919	0.31373	0.48	0.79922	0.02143
	Minimum S	0.08333	0.11275 0.01732	-0.02941		-1.42887	-1.90985	-2.555	0.0049	0.00383	-0.24415	-0.02956
	Maximum Regression Statistics 0.91667 MSE	0.90196 0.0021	0.01471		1.42887	1.14988	1.18206	0.31373	0.48	0.79922	0.02143
	Mean RMSE R R-Squared Adjusted R-Squared PRESS PRESS RMSE Patients 0-49 age group: Early Detected 0.5 0.50735 -0.9996 0.04583 0.00735 0.99919 0.99919 0.00248 0.0176	0.	-0.45127	-0.55408	0.125	0.09013	0.0292	-0.00648
	Scatter Diagram (Predicted Y, Median Ranks vs. 0.01732 Predicted R-Squared S 0.99904
	MSE N Patients 0-49 age group: Late Detected 0.0021 8 YEAR ) RMSE 0.04583 Median Ranks = 0.11275 * YEAR
	PRESS			0.00248
	Linear Regression: Poland, Patient age 0-49, late HIV detected. PRESS RMSE 0.0176
	Predicted R-Squared ANOVA		0.99904
	Regression Statistics N d.f.		SS	8		MS		F	p-value
	R R-Squared Median Ranks = 0.11275 * YEAR Regression 1. 0.99919 0.9996 2.59314 Residual 7. 0.0021		2.59314 0.0003		8,640.33333	4.39364E-12
	Adjusted R-Squared Total	8.	0.99919 2.59524
	S ANOVA			0.01732
	MSE RMSE PRESS Regression Intercept	d.f. Coefficient 1. 0	0.0021 0.04583 0.00248 Residuals vs YEAR SS MS 2.59314 2.59314 Standard LCL Error 8,640.33333 F UCL	p-value t Stat 4.39364E-12	p-value	H0 (5%)	VIF	TOL
	PRESS RMSE Predicted R-Squared Residual Total YEAR 0.11275 7. 8. T (5%) 2.36462	0.0176 0.99904 0.0021 0.00121 2.59524		0.0003 0.10988		0.11561	92.95339	4.39364E-12	rejected	**	**
	N LCL -Lower limit of the 95% confidence interval 8 Coefficient Standard Error UCL -Upper limit of the 95% confidence interval	LCL		UCL	t Stat	p-value	H0 (5%)	VIF	TOL
	Median Ranks = 0.11275 * YEAR Intercept 0
	YEAR	0.11275	0.00121		0.10988		0.11561	92.95339	4.39364E-12	rejected	**	**
	ANOVA T (5%) Residuals	2.36462
	d.f. LCL -Lower limit of the 95% confidence interval SS Observation Median Ranks Predicted Y	MS Residual	F Standardized [Excel]	p-value Studentized	Deleted t	Leverage	Cook's D	DFIT	PRESS
	Regression UCL -Upper limit of the 95% confidence interval 1. 2.59314 2.59314 1 0.08333 0.11275 0.02941 -	8,640.33333 -1.42887	4.39364E-12 -1.90985	-2.555	0.0049	0.01427	-0.17933	-0.02956
	Residual 2	7. 0.20238	0.0021 0.22549	0.0003 0.02311 -		-1.02062	-1.51181	-1.70552	0.01961	0.0363	-0.2412	-0.02357
	Total Residuals 3	8. 0.32143	2.59524 0.33824		-0.01681		-0.61237	-1.1135	-1.13645	0.04412	0.04544	-0.24415	-0.01758
	Intercept YEAR Observation 4 1 5 2 6 7 T (5%) 3 8	Coefficient 0 0.11275 Median Ranks 0.44048 0.08333 0.55952 0.20238 0.67857 0.79762 2.36462 0.32143 0.91667	Standard Error 0.00121 Predicted Y 0.45098 0.11275 0.56373 0.22549 0.67647 0.78922 0.33824 0.90196	LCL 0.10988 Residual -0.0105 -0.02941 -0.0042 0.0021 -0.02311 0.0084 -0.01681 0.01471	UCL 0.11561 Standardized [Excel] -0.20412 -1.42887 0.20412 0.61237 -1.02062 1.02062 -0.61237 1.42887	t Stat 92.95339 Studentized 4.39364E-p-value Deleted t -0.70878 -0.68109 -1.90985 -2.555 H0 (5%) rejected Leverage ** 0.07843 0.0049 -0.29055 -0.27063 0.12255 0.14996 0.13906 0.17647 -1.51181 -1.70552 0.01961 0.62447 0.59496 0.2402 12 -1.1135 -1.13645 0.04412 1.14988 1.18206 0.31373	VIF 0.03395 ** Cook's D 0.01427 0.00936 0.00383 0.0363 0.0979 0.04544 0.48	TOL -0.1987 DFIT 0.17933 --0.10114 0.06437 -0.2412 0.33452 -0.24415 0.79922	-0.0114 PRESS -0.00479 -0.02956 0.00255 -0.02357 0.01106 -0.01758 0.02143
	LCL -Lower limit of the 95% confidence interval UCL -Upper limit of the 95% confidence interval 4 0.44048 0.45098 5 0.55952 0.56373 Minimum 0.08333 0.11275 Maximum 0.91667 0.90196	-0.0105 -0.0042 -0.02941 0.01471		-0.20412 0.20412 -1.42887 1.42887	-0.70878 -0.29055 -1.90985 1.14988	-0.68109 -0.27063 -2.555 1.18206	0.07843 0.12255 0.0049 0.31373	0.03395 0.00936 0.00383 0.48	-0.1987 -0.24415 -0.10114 0.79922	-0.0114 -0.02956 -0.00479 0.02143
	** -Requires Pro version, please upgrade. 6 0.67857 0.67647 Mean 0.5 0.50735		0.0021 -0.00735		0.61237 0.	0.14996 -0.45127	0.13906 -0.55408	0.17647 0.125	0.00383 0.09013	0.06437 0.0292	0.00255 -0.00648
	7	0.79762	0.78922		0.0084		1.02062	0.62447	0.59496	0.2402	0.0979	0.33452	0.01106
	Residuals 8	0.91667	0.90196		0.01471		1.42887	1.14988	1.18206	0.31373	0.48	0.79922	0.02143
	Observation Minimum	Median Ranks 0.08333	Predicted Y 0.11275	Residual 0.02941 -	Standardized [Excel] -1.42887 Studentized -1.90985	Deleted t -2.555 Leverage 0.0049 Cook's D 0.00383	DFIT 0.24415 -	PRESS -0.02956
	1 Maximum 2 Mean	0.08333 0.91667 0.20238 0.5	0.11275 0.90196 0.22549 0.50735	-0.02941 0.01471 -0.02311 -0.00735		-1.42887 1.42887 -1.02062 0.	-1.90985 1.14988 -1.51181 -0.45127	-2.555 1.18206 -1.70552 -0.55408	0.0049 0.31373 0.01427 0.01961 0.0363 0.125 0.09013 0.48 0.17933 -0.79922 -0.2412 0.0292	0.02143 -0.02956 -0.02357 -0.00648
	3	0.32143	0.33824		-0.01681		-0.61237	-1.1135	-1.13645	0.04412	0.04544	-0.24415	-0.01758
	4	0.44048	0.45098		-0.0105		-0.20412	-0.70878	-0.68109	0.07843	0.03395	-0.1987	-0.0114
									279

** -Requires Pro version, please upgrade. ** -Requires Pro version, please upgrade.

Linear Regression: UK, Patient age 0-49, early HIV detected.

	Maximum	0.99654	1.35659	0.65739	1.38881	1.77673	2.35614	0.31527	0.60111	0.33405	0.67061
	Mean	0.98626	0.84787	0.13839	0.	0.34223	0.43046	0.14286	0.13059	-0.03372	0.11454
	Regression Statistics
	R		0.92588
	R-Squared		0.85726
	Adjusted R-Squared	0.85726
	S		0.40249
	MSE		0.97198
	RMSE		0.98589
	PRESS		1.23127
	PRESS RMSE		0.4194
	Predicted R-Squared	0.81918
	N		7
	1 = 0.16957 * 1
	ANOVA
		d.f.	SS	MS	F	p-value
	Regression	1.	5.8373	5.8373	36.03338	0.00096
	Residual	6.	0.97198	0.162
	Total	7.	6.80928
		Coefficient	Standard Error	LCL	UCL	t Stat	p-value	H0 (5%)	VIF	TOL
	Intercept	0
	1	0.16957	0.02825	0.10045	0.2387	6.00278	0.00096	rejected	**	**
	T (5%)	2.44691
	LCL -Lower limit of the 95% confidence interval
	UCL -Upper limit of the 95% confidence interval
	** -Requires Pro version, please upgrade.
	Residuals
	Observation	1	Predicted Y	Residual	Standardized [Excel]	Studentized	Deleted t	Leverage	Cook's D	DFIT	PRESS
	1	0.99654	0.33915	0.65739	1.38881	1.77673	2.35614	0.0197	0.0547	0.33405	0.67061
	2	0.99309	0.50872	0.48437	0.92582	1.32587	1.43946	0.04433	0.07031	0.31004	0.50684
	3	0.98966	0.67829	0.31136	0.46286	0.8681	0.84747	0.07882	0.05559	0.24789	0.338
	4	0.98623	0.84787	0.13837	-0.00007	0.39541	0.36575	0.12315	0.01893	0.13707	0.1578
	5	0.98282	1.01744	-0.03462	-0.46296	-0.10213	-0.09331	0.17734	0.00194	-0.04332	-0.04208
	6	0.97943	1.18701	-0.20759	-0.92582	-0.63777	-0.603	0.24138	0.11157	-0.34014	-0.27364
	7	0.97604	1.35659	-0.38055	-1.38865	-1.23062	-1.29927	0.31527	0.60111	-0.88162	-0.55576
	Minimum	0.97604	0.33915	-0.38055	-1.38865	-1.23062	-1.29927	0.0197	0.00194	-0.88162	-0.55576
					285

Scatter Diagram (Predicted Y, 1 vs. 1 ) Residuals vs 1 Linear Regression: UK, Patient age 0-49, late HIV detected.

	PRESS				1.23751
	PRESS RMSE				0.42046
	Predicted R-Squared		0.81248
	N				7
	Regression Statistics 1 = 0.16642 * 1
	R				0.91049
	R-Squared				0.82899
	Adjusted R-Squared ANOVA		0.82899
	S		d.f.		0.40834 SS	MS	F			p-value
	MSE Regression			1.	1.00044 5.62199	5.62199	34.51962	0.00108
	RMSE PRESS Residual Total			6. 7.	1.00022 1.26621 0.97718 Residuals vs 1 0.16286 6.59917
	PRESS RMSE				0.42531
	Predicted R-Squared N Coefficient	0.78356 7 Standard Error	LCL	UCL		t Stat	p-value	H0 (5%)	VIF	TOL
	Intercept			0
	1 = 0.15457 * 1 1	0.16642	0.02832	0.09711		0.23572	5.87534	0.00108	rejected	**	**
	T (5%)		2.44691
	LCL -Lower limit of the 95% confidence interval
	ANOVA UCL -Upper limit of the 95% confidence interval
			d.f.		SS	MS	F			p-value
	Regression			1.	4.84976	4.84976	29.08572	0.00167
	Residual Residuals			6.	1.00044	0.16674
	Total Observation		1	7.	5.8502 Predicted Y	Residual	Standardized [Excel]		Studentized	Deleted t	Leverage	Cook's D	DFIT	PRESS
	1 2	Coefficient 0.99237 0.98491	0.33283 Standard Error 0.49925	0.65953 LCL 0.48566	1.38984 UCL 0.92581	1.77777 t Stat 1.32586	2.35905 p-value 1.43944	0.0197 H0 (5%) 0.04433	0.05476 VIF 0.0703	0.33446 TOL 0.31004	0.67279 0.50819
	Intercept 3		0 0.97763	0.66567	0.31196		0.46224	0.86745	0.84675	0.07882	0.0555	0.24768	0.33865
	1 4		0.15457 0.97052	0.02866 0.83208	0.08444 0.13843		0.22469 -0.00088	5.39312 0.39454	0.00167 0.36493	rejected 0.12315	** 0.01885	** 0.13676	0.15787
	T (5%) 5		2.44691 0.96357	0.9985	-0.03493		-0.46356	-0.10279	-0.09392	0.17734	0.00196	-0.04361	-0.04246
	LCL -Lower limit of the 95% confidence interval 6 0.95678 1.16492 0.20814 -UCL -Upper limit of the 95% confidence interval 7 0.95015 1.33133 -0.38119		-0.92581 -1.38764	-0.63776 -1.2294	-0.60299 -1.29756	0.24138 0.31527	0.11157 0.59992	-0.34013 -0.88046	-0.27436 -0.5567
	Minimum		0.95015	0.33283	-0.38119		-1.38764	-1.2294	-1.29756	0.0197	0.00196	-0.88046	-0.5567
	Residuals Maximum		0.99237	1.33133	0.65953		1.38984	1.77777	2.35905	0.31527	0.59992	0.33446	0.67279
	Observation Mean		1 0.97085	Predicted Y 0.83208	Residual 0.13876	Standardized [Excel]	0.	Studentized 0.34224	Deleted t 0.43081	Leverage 0.14286	Cook's D 0.13041	DFIT 0.03361 -	PRESS 0.11486
	1		0.97728	0.30913	0.66815		1.39199	1.77994	2.36516	0.0197	0.0549	0.33532	0.68158
	2		0.95509	0.4637	0.4914		0.92579	1.32584	1.4394	0.04433	0.0703	0.31003	0.5142
	3		0.93342	0.61826	0.31516		0.46094	0.8661	0.84523	0.07882	0.05533	0.24724	0.34212
	4		0.91225	0.77283	0.13942		-0.00259	0.39271	0.3632	0.12315	0.01867	0.13611	0.159
	5 Patients 50+ age group: Early Detected 0.89157 0.92739 -0.03583	-0.46482	-0.10418	-0.09519	0.17734	0.00202	-0.0442	-0.04355
	6		0.87136	1.08196	-0.21059		-0.92579	-0.63774	-0.60296	0.24138	0.11156	-0.34012	-0.2776
	7		0.85163	1.23652	-0.38489		-1.38552	-1.22684	-1.29395	0.31527	0.59743	-0.87801	-0.56211
	Minimum Regression Statistics 0.85163	0.30913	-0.38489		-1.38552	-1.22684	-1.29395	0.0197	0.00202	-0.87801	-0.56211
	Maximum		0.97728	1.23652	0.66815		1.39199	1.77994	2.36516	0.31527	0.59743	0.33532	0.68158
	Mean R-Squared R		0.91323	0.77283 0.923 0.85192	0.1404			0.	0.34226	0.43155	0.14286	0.13003	-0.03337	0.11624
	Adjusted R-Squared		0.85192
	S				0.40356
	MSE				0.97718
	RMSE				0.98852
									287 288

** -Requires Pro version, please upgrade. Linear Regression: UK, Patient age 50+, early HIV detected. Scatter Diagram (Predicted Y, 1 vs. 1 ) ** -Requires Pro version, please upgrade. Scatter Diagram (Predicted Y, 1 vs. 1 ) Patients 50+ age group: Late Detected

Linear Regression: UK, Patient age 50+, late HIV detected.

	Residual	6.	1.05039	0.17507
	Total	7.	4.45883
	Coefficient	Standard Error	LCL	UCL	t Stat	p-value	H0 (5%)	VIF	TOL
	Intercept	0
	1	0.12958	0.02937	0.05772	0.20143	4.41242	0.00451	rejected	**	**
	T (5%)	2.44691
	LCL -Lower limit of the 95% confidence interval
	UCL -Upper limit of the 95% confidence interval
	** -Requires Pro version, please upgrade.
	Residuals
	Observation	1	Predicted Y	Residual	Standardized [Excel]	Studentized	Deleted t	Leverage	Cook's D	DFIT	PRESS
	1	0.94548	0.25915	0.68633	1.39636	1.78435	2.37761	0.0197	0.05517	0.33709	0.70012
	2	0.89223	0.38873	0.5035	0.92573	1.32578	1.43931	0.04433	0.0703	0.31001	0.52685
	3	0.84021	0.51831	0.3219	0.45828	0.86333	0.84215	0.07882	0.05498	0.24634	0.34944
	4	0.7894	0.64789	0.14151	-0.00606	0.389	0.35967	0.12315	0.01832	0.13479	0.16138
	5	0.73976	0.77746	-0.0377	-0.46738	-0.10701	-0.09778	0.17734	0.00213	-0.0454	-0.04583
	6	0.69127	0.90704	-0.21577	-0.92573	-0.63768	-0.60291	0.24138	0.11154	-0.34009	-0.28442
	7	0.64391	1.03662	-0.39271	-1.3812	-1.22163	-1.28662	0.31527	0.59236	-0.87304	-0.57353
	Minimum	0.64391	0.25915	-0.39271	-1.3812	-1.22163	-1.28662	0.0197	0.00213	-0.87304	-0.57353
	Maximum	0.94548	1.03662	0.68633	1.39636	1.78435	2.37761	0.31527	0.59236	0.33709	0.70012
	Mean	0.79175	0.64789	0.14386	0.	0.3423	0.43306	0.14286	0.12926	-0.0329	0.11915
	Regression Statistics
	R		0.87431
	R-Squared		0.76442
	Adjusted R-Squared	0.76442
	S		0.41841
	MSE		1.05039
	RMSE		1.02489
	PRESS		1.32783
	PRESS RMSE		0.43553
	Predicted R-Squared	0.7022
	N		7
	1 = 0.12958 * 1
	ANOVA
		d.f.	SS	MS	F	p-value
	Regression	1.	3.40844	3.40844	19.46947	0.00451

Scatter Diagram (Predicted Y, 1 vs. 1 )

Residuals vs 1

Acknowledgements

I would like to thank the following supporters:

Number of HIV+ Infections Avoided

Based on the initial 108 newly detected patients in the first year divided 42%/58% between late and early detection with 30-percent relative shift to 30/%70% respectively, or 15 patients annually shift from late to early detection and accounting for HIV incidence rate and transmission multiplier scalar, for year 1, 2, 3, 4, 5, number of HIV+ infections avoided will be 0, 0, 1, 2 and 4 respectively (Figure CLXV).

Cumulative Life Years Saved

Cumulative life years saved due to 30-percent relative shift from Late to Early Detection for year 1, 2, 3, 4, 5 will be 0, 0, 1, 3 and 7 life years respectfully.