Routine human immunodeficiency virus testing: An economic evaluation of current guidelines - 21/08/11
, Milton C. Weinstein, PhD d, April D. Kimmel a, George R. Seage, ScD, MPH c, Elena Losina, PhD e, Paul E. Sax, MD b, Hong Zhang, SM a, Heather E. Smith a, Kenneth A. Freedberg, MD, MSc a, A. David Paltiel, PhD f
Requests for reprints should be addressed to Rochelle P. Walensky, MD, MPH, Division of General Medicine, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, Massachusetts 02114.Résumé |
Background |
The Centers for Disease Control and Prevention guidelines recommend human immunodeficiency virus (HIV) counseling, testing, and referral for all patients in hospitals with an HIV prevalence of ≥1%. The 1% screening threshold has not been critically examined since HIV became effectively treatable in 1995. Our objective was to evaluate the clinical effect and cost-effectiveness of current guidelines and of alternate HIV prevalence thresholds.
Methods |
We performed a cost-effectiveness analysis using a computer simulation model of HIV screening and disease as applied to inpatients in U.S. hospitals.
Results |
At an undiagnosed inpatient HIV prevalence of 1% and an overall participation rate of 33%, HIV screening increased mean quality-adjusted life expectancy by 6.13 years per 1000 inpatients, with a cost-effectiveness ratio of $35 400 per quality-adjusted life-year (QALY) gained. Expansion of screening to settings with a prevalence as low as 0.1% increased the ratio to $64 500 per QALY gained. Increasing counseling and testing costs from $53 to $103 per person still yielded a cost-effectiveness ratio below $100 000 per QALY gained at a prevalence of undiagnosed infection of 0.1%.
Conclusion |
Routine inpatient HIV screening programs are not only cost-effective but would likely remain so at a prevalence of undiagnosed HIV infection 10 times lower than recommended thresholds. The current HIV counseling, testing, and referral guidelines should now be implemented nationwide as a way of linking infected patients to life-sustaining care.
Le texte complet de cet article est disponible en PDF.Key words : HIV/AIDS, HIV EIA, Testing, Screening, Cost-effectiveness
Plan
| This research was funded by the National Institute of Allergy and Infectious Diseases (K23AI01794, K24AI062476, K25AI50436, R01AI42006, Center for AIDS Research P30AI42851), the National Institute of Mental Health (R01MH65869), the National Institute on Drug Abuse (R01DA015612), and the Centers for Disease Control and Prevention (S1396-20/21). |
Vol 118 - N° 3
P. 292-300 - mars 2005 Retour au numéro
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