The cost-effectiveness of HIV testing of physicians and dentists in the United States.
OBJECTIVE
To evaluate the cost-effectiveness of alternative policies for human immunodeficiency testing (HIV) testing of physicians and dentists.


METHODS
Decision analysis and cost-effectiveness analysis from a societal perspective were used. Data were derived from extensive literature review and consultation with experts. We conducted sensitivity analyses and also performed a cost-benefit analysis.


METHODS
We analyzed policies for mandatory or voluntary testing of all physicians, surgeons, and dentists; for those testing positive, we analyzed mandatory or voluntary exclusion from practice, restriction from performance of invasive procedures, or requirements to inform patients of serostatus.


METHODS
Cost per patient infection averted.


RESULTS
Although one-time mandatory testing of surgeons and dentists with mandatory restriction of those found to be HIV-positive is more cost-effective than other policies, the cost-effectiveness varies tremendously under different scenarios. Results were highly sensitive to several data inputs, especially HIV seroprevalence of surgeons and dentists and transmission risk. For example, under a medium seroprevalence and transmission risk scenario, mandatory testing of all surgeons might avert 25 infections at a total cost of $27.9 million or $1,115,000 per infection averted and an incremental cost of $291,000 compared with current testing; however, the incremental cost-effectiveness per patient infection averted ranges from $29,807,000 under a low-risk scenario to a savings of $81,000 under a high-risk scenario.


CONCLUSIONS
Our analysis neither justifies nor precludes a mandatory testing policy. Further research on the key data inputs is needed. Given the ethical, social, and public health implications, mandatory testing policies should not be implemented without greater certainty as to their cost-effectiveness.
Phillips
K A
KA
Center for AIDS Prevention Studies, School of Medicine, University of California-San Francisco.
Lowe
R A
RA
Kahn
J G
JG
Lurie
P
P
Avins
A L
AL
Ciccarone
D
D
D015492:AIDS Serodiagnosis / Q000191:economics* / Q000331:legislation & jurisprudence / Q000592:standards; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003815:Dentists / Q000592:standards / Q000706:statistics & numerical data; D030881:Disclosure; D035082:Federal Government; D015658:HIV Infections / Q000191:economics / Q000517:prevention & control / Q000635:transmission*; D015528:HIV Seroprevalence; D006291:Health Policy / Q000191:economics*; D006801:Humans; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000191:economics / Q000517:prevention & control*; D010820:Physicians / Q000592:standards / Q000706:statistics & numerical data; D014481:United States; D035141:Voluntary Programs