S'abonner

Cost-Effectiveness of HIV Screening in Emergency Departments: Results From the Pragmatic Randomized HIV Testing Using Enhanced Screening Techniques in Emergency Departments Trial - 24/04/24

Doi : 10.1016/j.annemergmed.2024.03.009 
Jason Haukoos, MD, MSc a, b, c, d, , Emily Hopkins, MSPH a, b, d, Jonathan D. Campbell, PhD e, Michael S. Lyons, MD, MPH f, Richard E. Rothman, MD, PhD g, Yu-Hsiang Hsieh, PhD g, Douglas A.E. White, MD h, Stacy Trent, MD, MPH a, b, d, Alia A. Al-Tayyib, PhD c, i, Edward M. Gardner, MD i, j, k, Allison L. Sabel, MD, PhD l, m, Sarah E. Rowan, MD i, j, k
for the

HIV Testing Using Enhanced Screening Techniques in Emergency Departments (TESTED) Trial Investigators

Bryan Austin, Jacob Cohen, Jackie Easley, Somiya Haider, Peter Hill, Mauren Henley, Gabor Kelen, Maggie Leathers, Barbara Maliszewski, Paula Neira, Scott Newton, Stephen Peterson, Mustapha Saheed, Danielle Signer, Lucas Spaeth, Tina Tolson, Matthew Toerper, Valentina Viertel, Maddie Whalen, Rachel Ancona, Catherine Cronin, Frank Fernandez, Carl Fichtenbaum, Cortney Gaffney, Cathy Hamilton, Kim Hart, Dave Hoskins, Sharon Kohrs, Christopher Lindsell, Chris Miller, Brittany Punches, Andrew Ruffner, Geri Rowan, Kim Vance, Teresa Williams, Meggan Bucossi, Steve Cantrill, Angelica Chavez, Ann Comeau, Tracy Daugherty, Alex Delgado, Pamela Doyle, Roberto Esquivel, Maren Fassino, Kelly Finnegan, Greg Fliney, Theresa Freudig, Michael Fuhriman, Mary Gillman, Stacey Kahl-Geiger, Korina Keating, Jason Koerner, Karen Laber, Meghan Lang, Carolynn Lyle, Kim Makela, Mary Maltby, David Medina, Tanya Nielsen, Alice Ortiz, Angela Paolucci, Don Pate, Michael Pippins, Steven Roy, John Searcey, Jerry Solot, Kelly Stermer, Brian Stuart, Melissa Swanson, Lauren Timkovich, Zenia Toure, Lisa Vogel, Sommer Walker, Diane Weed, Julia Weise, Kerri Wenke, Courtney Wham, Michael Wilson, Jarrod Wright, Melody Zwakenberg, Harrison Alter, Erik Anderson, Brendan Campbell, Grace Chang, Connie Chao, Katie Ellis, Sarah Graffman, Brynn Kron, Rebecca Lucas, Caitlin McCarthy, Valerie Ng, Christine O’Dell, Jim Peck, Mae Petti, Sarah Pfeil, Feuy Saechao, Barry Simon, Tamara Todorovic, Tonya Tyree

a Department of Emergency Medicine, Denver Health Medical Center, Denver, CO 
b Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO 
c Department of Epidemiology, Colorado School of Public Health, Aurora, CO 
d Colorado Social Emergency Medicine Collaborative, Denver, CO 
e National Pharmaceutic Council, Washington, DC 
f Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 
g Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD 
h Department of Emergency Medicine, Highland Hospital, Alameda Health System, Oakland, CA 
i Public Health Institute at Denver Health, Denver, CO 
j Division of Infectious Diseases, Denver Health Medical Center, Denver, CO 
k Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, CO 
l Department of Patient Safety and Quality Denver Health, Denver, CO 
m Department of Biostatistics, Colorado School of Public Health, Aurora, CO 

Corresponding Author.
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 24 April 2024
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Abstract

Study objective

Identification of HIV remains a critical health priority for which emergency departments (EDs) are a central focus. The comparative cost-effectiveness of various HIV screening strategies in EDs remains largely unknown. The goal of this study was to compare programmatic costs and cost-effectiveness of nontargeted and 2 forms of targeted opt-out HIV screening in EDs using results from a multicenter, pragmatic randomized clinical trial.

Methods

This economic evaluation was nested in the HIV Testing Using Enhanced Screening Techniques in Emergency Departments (TESTED) trial, a multicenter pragmatic clinical trial of different ED-based HIV screening strategies conducted from April 2014 through January 2016. Patients aged 16 years or older, with normal mental status and not critically ill, or not known to be living with HIV were randomized to 1 of 3 HIV opt-out screening approaches, including nontargeted, enhanced targeted, or traditional targeted, across 4 urban EDs in the United States. Each screening method was fully integrated into routine emergency care. Direct programmatic costs were determined using actual trial results, and time-motion assessment was used to estimate personnel activity costs. The primary outcome was newly diagnosed HIV. Total annualized ED programmatic costs by screening approach were calculated using dollars adjusted to 2023 as were costs per patient newly diagnosed with HIV. One-way and multiway sensitivity analyses were performed.

Results

The trial randomized 76,561 patient visits, resulting in 14,405 completed HIV tests, and 24 (0.2%) new diagnoses. Total annualized new diagnoses were 12.9, and total annualized costs for nontargeted, enhanced targeted, and traditional targeted screening were $111,861, $88,629, and $70,599, respectively. Within screening methods, costs per new HIV diagnoses were $20,809, $23,554, and $18,762, respectively. Enhanced targeted screening incurred higher costs but with similar annualized new cases detected compared with traditional targeted screening. Nontargeted screening yielded an incremental cost-effectiveness ratio of $25,586 when compared with traditional targeted screening. Results were most sensitive to HIV prevalence and costs of HIV tests.

Conclusion

Nontargeted HIV screening was more costly than targeted screening largely due to an increased number of HIV tests performed. Each HIV screening strategy had similar within-strategy costs per new HIV diagnosis with traditional targeted screening yielding the lowest cost per new diagnosis. For settings with budget constraints or very low HIV prevalences, the traditional targeted approach may be preferred; however, given only a slightly higher cost per new HIV diagnosis, ED settings looking to detect the most new cases may prefer nontargeted screening.

Le texte complet de cet article est disponible en PDF.

Plan


 Supervising editor: Nicholas M. Mohr, MD, MS. Specific detailed information about possible conflict of interest for individual editors is available at editors.
 Author contributions: JH, EH, JDC, MSL, RER, DAEW are responsible for study concept and design. JH, EH, MSL, RER, DAEW were involved in acquisition of data. JH, EH, JDC, MSL, RER, Y-HH, DAEW, ST, AAA-T, EMG, SER were involved in analysis and interpretation of data. JH, EH drafted the manuscript. All authors critically revised the manuscript for important intellectual content. JH, EH, JDC were involved in statistical analyses. JH obtained funding. JH, EH, MSL, RER, DAEW provided administrative, technical, or material support. JH, MSL, RER, DAEW were responsible for study supervision. JH had full access to all of the data in the study and takes responsibility for the integrity of the data, the accuracy of the data analysis, and the study as a whole.
 Data sharing statement: All deidentified data, the data dictionary, and analytic code supporting this publication are available from the time of publication upon request to Dr. Haukoos at jason.haukoos@dhha.org.
 All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
 Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). JH was supported, in part, by the National Institute of Allergy and Infectious Diseases (NIAID) (R01AI106057), the National Institute on Drug Abuse (R01DA042982), and the Agency for Healthcare Research and Quality (AHRQ) (K02HS017526 and R01HS021749). MSL was supported, in part, by NIAID (R01AI106057), NIDA (R01DA049282), AHRQ (R01HS021749), the Cincinnati Health Network, Hamilton County Public Health, and Gilead Sciences, Inc. RER was supported, in part, by NIAID (R01AI106057), NIDA (R01DA049282), AHRQ (R01HS021749), the Maryland Department of Health and Mental Hygiene, and Gilead Sciences, Inc. DAEW was supported by NIAID (R01AI106057), NIDA (R01DA049282), and Gilead Sciences, Inc. This study was funded by an investigator-initiated grant from NIAID (R01AI106057). NIAID, NIDA, AHRQ, and Gilead Sciences, Inc. had no role in the design, conduct, or reporting of the study. NIAID reviewed the study design but had no role in the design or conduct of the study, or collection, management, analyses, or interpretation of data.
 Please see page XX for the Editor’s Capsule Summary of this article.


© 2024  American College of Emergency Physicians. Publié par Elsevier Masson SAS. Tous droits réservés.
Ajouter à ma bibliothèque Retirer de ma bibliothèque Imprimer
Export

    Export citations

  • Fichier

  • Contenu

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

Déjà abonné à cette revue ?

Mon compte


Plateformes Elsevier Masson

Déclaration CNIL

EM-CONSULTE.COM est déclaré à la CNIL, déclaration n° 1286925.

En application de la loi nº78-17 du 6 janvier 1978 relative à l'informatique, aux fichiers et aux libertés, vous disposez des droits d'opposition (art.26 de la loi), d'accès (art.34 à 38 de la loi), et de rectification (art.36 de la loi) des données vous concernant. Ainsi, vous pouvez exiger que soient rectifiées, complétées, clarifiées, mises à jour ou effacées les informations vous concernant qui sont inexactes, incomplètes, équivoques, périmées ou dont la collecte ou l'utilisation ou la conservation est interdite.
Les informations personnelles concernant les visiteurs de notre site, y compris leur identité, sont confidentielles.
Le responsable du site s'engage sur l'honneur à respecter les conditions légales de confidentialité applicables en France et à ne pas divulguer ces informations à des tiers.


Tout le contenu de ce site: Copyright © 2024 Elsevier, ses concédants de licence et ses contributeurs. Tout les droits sont réservés, y compris ceux relatifs à l'exploration de textes et de données, a la formation en IA et aux technologies similaires. Pour tout contenu en libre accès, les conditions de licence Creative Commons s'appliquent.