title: Budget impact analysis of HIV testing in the VA healthcare system.
abstract: OBJECTIVE
  The long-term cost effectiveness of routine HIV testing is favorable relative to other medical interventions. Facility-specific costs of expanded HIV testing and care for newly identified patients, however, are less well defined. To aid in resource allocation decisions, we developed a spreadsheet-based budget-impact tool populated with estimates of facility-specific HIV testing and care costs incurred with an expanded testing program.
  
  
  METHODS
  We modeled intervention effects on quarterly costs of antiretroviral therapy (ART), outpatient resource utilization, and staff expenditures in the Department of Veterans Affairs over a 2-year period of increasing HIV testing rates. We used HIV prevalence estimates, screening rates, counseling, positive tests, Veterans Affairs treatment, and published sources as inputs. We evaluated a single-facility cohort of 20,000 patients and at baseline assumed a serodiagnostic rate of 0.45%.
  
  
  RESULTS
  Expanding testing from 2% to 15% annually identified 21 additional HIV-positive patients over 2 years at a cost of approximately $290,000, more than 60% of which was due to providing ART to newly diagnosed patients. While quarterly testing costs decreased longitudinally as fewer persons required testing, quarterly ART costs increased from $10,000 to more than $60,000 over 2 years as more infected patients were identified and started on ART. In sensitivity analyses, serodiagnostic and annual HIV testing rates had the greatest cost impact.
  
  
  CONCLUSIONS
  Expanded HIV testing costs are greatest during initial implementation and predominantly due to ART for new patients. Cost determinations of expanded HIV testing provide an important tool for managers charged with allocating resources within integrated systems providing both HIV testing and care.
authors.affiliation: Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Health Services Research and Development Center of Excellence, VA Greater Los Angeles Healthcare System, CA 90073, USA. henry.anaya@va.gov
authors.forename: Henry D
authors.initials: HD
authors.lastname: Anaya
authors.forename: Kee
authors.initials: K
authors.lastname: Chan
authors.forename: Uday
authors.initials: U
authors.lastname: Karmarkar
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.forename: Matthew
authors.initials: M
authors.lastname: Bidwell Goetz
mesh_terms: D015492:AIDS Serodiagnosis; D044966:Anti-Retroviral Agents / Q000191:economics / Q000627:therapeutic use; D002017:Budgets / Q000706:statistics & numerical data*; D018791:CD4 Lymphocyte Count; D003362:Cost-Benefit Analysis; D015658:HIV Infections / Q000175:diagnosis* / Q000178:diet therapy / Q000191:economics*; D006282:Health Personnel / Q000191:economics; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D012680:Sensitivity and Specificity; D014481:United States; D014493:United States Department of Veterans Affairs; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents