The cost-effectiveness of HIV testing: accounting for differential participation rates.
OBJECTIVE
To understand the impact of differences in participation rates between infected and uninfected individuals on estimates of the cost-effectiveness of HIV screening.


METHODS
Costs per infection detected are modeled as function of both prevalence and serostatus-dependent testing rates. Data from national surveillance surveys, seroprevalence studies, and other sources are employed to suggest the magnitude of results.


RESULTS
Differential participation produces a near-doubling in the estimated cost per infection identified. This result is sensitive to assumptions regarding the benefits of screening for seronegatives.


CONCLUSIONS
Voluntary HIV screening programs may incur prohibitive costs by over-recruiting people at little risk of infection. Failure to account for differential participation can result in over-optimistic cost-effectiveness estimates. However, the relevance of this result--and the significance of both prevalence and participation as cost drivers--is overwhelmed by what is assumed about the benefits conferred to uninfected people by HIV screening.
Paltiel
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AD
Yale School of Medicine, New Haven, Connecticut, USA. david.paltiel@yale.edu
Kaplan
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EH
D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D015658:HIV Infections / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D015528:HIV Seroprevalence; D006291:Health Policy; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D017059:Models, Econometric; D014481:United States / Q000453:epidemiology