Comparing the costs of HIV screening strategies and technologies in health-care settings.
OBJECTIVE
In 2006, the Centers for Disease Control and Prevention (CDC) recommended routine human immunodeficiency virus (HIV) screening for people aged 13 to 64 years in all U.S. health-care settings. Earlier recommendations focused on those at high risk for HIV and included more extensive pretest counseling. HIV screening may also involve either rapid or conventional testing. The purpose of this research was to estimate the costs of these different testing procedures and the cost per HIV-infected patient correctly receiving test results in three health-care scenarios that illustrated these policy differences.


METHODS
The study estimated the costs of rapid and conventional HIV testing in the following scenarios: (1) sexually transmitted disease (STD) clinic counseling and testing (CT), (2) STD clinic screening, and (3) emergency department (ED) screening. Costs were estimated from the provider perspective in 2006 dollars. A decision analytic model was developed to estimate the cost per HIV-infected patient notified of test results using the two testing procedures in the three scenarios.


RESULTS
Although the complete rapid testing procedure was more expensive than conventional testing, the cost per HIV-infected patient receiving test results was lower for the rapid test compared with conventional testing in all scenarios. Per-patient costs of receiving results were lowest in the ED screening scenario and highest in the STD CT scenario. These costs were sensitive to changes in test costs, HIV prevalence, and return rates following conventional tests.


CONCLUSIONS
HIV screening in general health-care settings is economically feasible, particularly with rapid tests that lower the cost of HIV-infected patients receiving their test results.
Farnham
Paul G
PG
Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, MS E-48, Atlanta, GA 30333, USA. pgf1@cdc.gov
Hutchinson
Angela B
AB
Sansom
Stephanie L
SL
Branson
Bernard M
BM
D015492:AIDS Serodiagnosis; D000293:Adolescent; D000328:Adult; D003657:Decision Making; D003661:Decision Support Techniques; D037001:Directive Counseling; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control; D015528:HIV Seroprevalence; D017048:Health Care Costs; D005102:Health Expenditures; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology; D055815:Young Adult