title: The cost-effectiveness of rapid HIV testing in substance abuse treatment: results of a randomized trial.
abstract: BACKGROUND
  The President's National HIV/AIDS Strategy calls for coupling HIV screening and prevention services with substance abuse treatment programs. Fewer than half of US community-based substance abuse treatment programs make HIV testing available on-site or through referral.
  
  
  METHODS
  We measured the cost-effectiveness of three HIV testing strategies evaluated in a randomized trial conducted in 12 community-based substance abuse treatment programs in 2009: off-site testing referral, on-site rapid testing with information only, on-site rapid testing with risk-reduction counseling. Data from the trial included patient demographics, prior testing history, test acceptance and receipt of results, undiagnosed HIV prevalence (0.4%) and program costs. The Cost-Effectiveness of Preventing AIDS Complications (CEPAC) computer simulation model was used to project life expectancy, lifetime costs, and quality-adjusted life years (QALYs) for HIV-infected individuals. Incremental cost-effectiveness ratios (2009 US $/QALY) were calculated after adding costs of testing HIV-uninfected individuals; costs and QALYs were discounted at 3% annually.
  
  
  RESULTS
  Referral for off-site testing is less efficient (dominated) compared to offering on-site testing with information only. The cost-effectiveness ratio for on-site testing with information is $60,300/QALY in the base case, or $76,300/QALY with 0.1% undiagnosed HIV prevalence. HIV risk-reduction counseling costs $36 per person more without additional benefit.
  
  
  CONCLUSIONS
  A strategy of on-site rapid HIV testing offer with information only in substance abuse treatment programs increases life expectancy at a cost-effectiveness ratio <$100,000/QALY. Policymakers and substance abuse treatment leaders should seek funding to implement on-site rapid HIV testing in substance abuse treatment programs for those not recently tested.
authors.affiliation: Department of Public Health, Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065, USA. brs2006@med.cornell.edu
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Schackman
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Metsch
authors.forename: Grant N
authors.initials: GN
authors.lastname: Colfax
authors.forename: Jared A
authors.initials: JA
authors.lastname: Leff
authors.forename: Angela
authors.initials: A
authors.lastname: Wong
authors.forename: Callie A
authors.initials: CA
authors.lastname: Scott
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Feaster
authors.forename: Lauren
authors.initials: L
authors.lastname: Gooden
authors.forename: Tim
authors.initials: T
authors.lastname: Matheson
authors.forename: Louise F
authors.initials: LF
authors.lastname: Haynes
authors.forename: A David
authors.initials: AD
authors.lastname: Paltiel
authors.forename: Rochelle P
authors.initials: RP
authors.lastname: Walensky
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D015995:Prevalence; D019057:Quality-Adjusted Life Years; D019966:Substance-Related Disorders / Q000150:complications* / Q000191:economics / Q000628:therapy