title: Cost effectiveness of screening strategies for early identification of HIV and HCV infection in injection drug users.
abstract: OBJECTIVE
  To estimate the cost, effectiveness, and cost effectiveness of HIV and HCV screening of injection drug users (IDUs) in opioid replacement therapy (ORT).
  
  
  METHODS
  Dynamic compartmental model of HIV and HCV in a population of IDUs and non-IDUs for a representative U.S. urban center with 2.5 million adults (age 15-59).
  
  
  METHODS
  We considered strategies of screening individuals in ORT for HIV, HCV, or both infections by antibody or antibody and viral RNA testing. We evaluated one-time and repeat screening at intervals from annually to once every 3 months. We calculated the number of HIV and HCV infections, quality-adjusted life years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs).
  
  
  RESULTS
  Adding HIV and HCV viral RNA testing to antibody testing averts 14.8-30.3 HIV and 3.7-7.7 HCV infections in a screened population of 26,100 IDUs entering ORT over 20 years, depending on screening frequency. Screening for HIV antibodies every 6 months costs $30,700/QALY gained. Screening for HIV antibodies and viral RNA every 6 months has an ICER of $65,900/QALY gained. Strategies including HCV testing have ICERs exceeding $100,000/QALY gained unless awareness of HCV-infection status results in a substantial reduction in needle-sharing behavior.
  
  
  CONCLUSIONS
  Although annual screening for antibodies to HIV and HCV is modestly cost effective compared to no screening, more frequent screening for HIV provides additional benefit at less cost. Screening individuals in ORT every 3-6 months for HIV infection using both antibody and viral RNA technologies and initiating ART for acute HIV infection appears cost effective.
authors.affiliation: Department of Management Science and Engineering, Stanford University, Stanford, California, USA. Lauren.Cipriano@gmail.com
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Cipriano
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Zaric
authors.forename: Mark
authors.initials: M
authors.lastname: Holodniy
authors.forename: Eran
authors.initials: E
authors.lastname: Bendavid
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Owens
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Brandeau
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000032:analysis*; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D055030:Drug Users / Q000706:statistics & numerical data; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000821:virology; D016174:Hepacivirus / Q000302:isolation & purification*; D006526:Hepatitis C / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics* / Q000821:virology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D018803:Models, Economic; D016485:Needle Sharing; D058850:Opiate Substitution Treatment; D019057:Quality-Adjusted Life Years; D012367:RNA, Viral / Q000032:analysis*; D018570:Risk Assessment; D019037:Urban Health Services
chemical_list: D000914:Antibodies, Viral; D012367:RNA, Viral