title: The cost-effectiveness of expanded HIV screening in the United States.
abstract: OBJECTIVE
  The current Centers of Disease Control and Prevention (CDC) guidelines from 2006 recommend a one-time test for low-risk individuals and annual testing for those at high risk. These guidelines may not be aggressive enough, even for those at low risk of infection, due to the earlier initiation of HAART and a movement towards a test-and-treat environment. We evaluated the optimal testing frequencies for various risk groups in comparison to the CDC recommendations.
  
  
  METHODS
  We build a deterministic mathematical model optimizing the tradeoff between the societal cost of testing and the benefits over a patient's lifetime of earlier diagnosis.
  
  
  RESULTS
  Under a test-and-treat scenario with immediate initiation of HAART, the optimal testing frequency is every 2.4 years for low-risk (0.01% annual incidence) individuals; every 9 months for moderate risk (0.1% incidence) individuals; and every 3 months for high-risk (1.0% incidence) individuals. The incremental cost-effectiveness of the optimal policy is $ 36 ,342/quality-adjusted life-years (QALY) for low-risk individuals and $ 45 ,074/QALY for high-risk individuals compared with 20-year and annual testing, respectively.
  
  
  CONCLUSIONS
  The current CDC guidelines for HIV testing are too conservative, and more frequent testing is cost-effective for all risk groups.
authors.affiliation: Department of Industrial Engineering and Management Science, Northwestern University, Evanston, IL, USA. aalucas@u.northwestern.edu
authors.forename: Aaron
authors.initials: A
authors.lastname: Lucas
authors.forename: Benjamin
authors.initials: B
authors.lastname: Armbruster
mesh_terms: D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D003362:Cost-Benefit Analysis; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics*; D006801:Humans; D008403:Mass Screening / Q000191:economics* / Q000379:methods; D008962:Models, Theoretical; D017410:Practice Guidelines as Topic; D019057:Quality-Adjusted Life Years; D012307:Risk Factors; D013997:Time Factors; D014481:United States