Cost-effectiveness of HIV screening in patients older than 55 years of age.
BACKGROUND
Although HIV infection is more prevalent in people younger than age 45 years, a substantial number of infections occur in older persons. Recent guidelines recommend HIV screening in patients age 13 to 64 years. The cost-effectiveness of HIV screening in patients age 55 to 75 years is uncertain.


OBJECTIVE
To examine the costs and benefits of HIV screening in patients age 55 to 75 years.


METHODS
Markov model.


METHODS
Derived from the literature.


METHODS
Patients age 55 to 75 years with unknown HIV status.


METHODS
Lifetime.


CONCLUSIONS
Societal.


METHODS
HIV screening program for patients age 55 to 75 years compared with current practice.


METHODS
Life-years, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness.


RESULTS
For a 65-year-old patient, HIV screening using traditional counseling costs $55,440 per QALY compared with current practice when the prevalence of HIV was 0.5% and the patient did not have a sexual partner at risk. In sexually active patients, the incremental cost-effectiveness ratio was $30,020 per QALY. At a prevalence of 0.1%, HIV screening cost less than $60,000 per QALY for patients younger than age 75 years with a partner at risk if less costly streamlined counseling is used.


RESULTS
Cost-effectiveness of HIV screening depended on HIV prevalence, age of the patient, counseling costs, and whether the patient was sexually active. Sensitivity analyses with other variables did not change the results substantially.


CONCLUSIONS
The effects of age on the toxicity and efficacy of highly active antiretroviral therapy and death from AIDS were uncertain. Sensitivity analyses exploring these variables did not qualitatively affect the results.


CONCLUSIONS
If the tested population has an HIV prevalence of 0.1% or greater, HIV screening in persons from age 55 to 75 years reaches conventional levels of cost-effectiveness when counseling is streamlined and if the screened patient has a partner at risk. Screening patients with advanced age for HIV is economically attractive in many circumstances.
Duke Clinical Research Institute, Durham, North Carolina 27715, USA.
Gillian D
GD
Sanders
Ahmed M
AM
Bayoumi
Mark
M
Holodniy
Douglas K
DK
Owens
D000367:Age Factors; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012725:Sexual Behavior