title: Comparative Cost Analysis of Clinical Reminder for HIV Testing at the Veterans Affairs Healthcare System.
abstract: OBJECTIVE
  To estimate the cost and health outcomes associated with a new HIV testing strategy that utilizes routine-based clinical reminders.
  
  
  METHODS
  We conducted an economic analysis of 1) traditional pretest/post-test counseling; 2) counseling and a new clinical reminders system; and 3) only clinical reminder in the veterans' health care system. A payer-perspective decision model was conducted to calculate the 1-year budget impact of three HIV testing strategies. Parameter values were obtained from the literature, including patients' probability of accepting test, and costs associated with HIV testing procedures. Deidentified patient data, including total population screened and number of new HIV cases, were collected from one clinic in Los Angeles, California, from August 2004 to December 2011. Annual total costs and costs per new case were calculated on the basis of parameter values and patient data. Sensitivity analyses were conducted to evaluate the robustness of the critical variable on costs.
  
  
  RESULTS
  The total cost of the clinical reminder system with pretest counseling was $81,726 over 1 year compared with $109,208 for traditional HIV testing. Under a clinical reminder system with no pretest counseling, the number of HIV tests performed and the number of new diagnoses increased for that year. In addition, cost per new diagnoses was the lowest.
  
  
  CONCLUSIONS
  The clinical reminder system can reduce the cost per cases identified and promote better performance of HIV testing compared with traditional HIV testing. The fundamental decision model can be used for hospital facilities outside the Veteran Affairs adopting a similar program for improving the HIV testing rate.
authors: Department of Health Sciences, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA; Center of Health, Quality, and Economics Research, Veterans Affairs, Bedford, MA, USA. Electronic address: keechan@bu.edu.
authors: Kee
authors: K
authors: Chan
authors: Department of Health Sciences, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA.
authors: Leilani
authors: L
authors: Hernandez
authors: Department of Health Sciences, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA.
authors: Heidi
authors: H
authors: Yang
authors: Infectious Diseases Section, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Infectious Diseases Section, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
authors: Matthew
authors: M
authors: Bidwell Goetz
mesh_terms: D015492:AIDS Serodiagnosis / Q000191:economics* / Q000379:methods*; D003365:Costs and Cost Analysis; D003376:Counseling / Q000191:economics*; D005260:Female; D006787:Hospitals, Veterans / Q000191:economics*; D006801:Humans; D015141:Los Angeles; D008297:Male; D017010:Reminder Systems / Q000191:economics*
keywords: AIDS; Veterans Affairs Healthcare System; cost analysis