title: Estimated cost per HIV infection diagnosed through routine HIV testing offered in acute general medical admission units and general practice settings in England.
abstract: OBJECTIVE
  Following national guidelines to expand HIV testing in high-prevalence areas in England, a number of pilot studies were conducted in acute general medical admission units (ACUs) and general practices (GPs) to assess the feasibility and acceptability of testing in these settings. The aim of this study was to estimate the cost per HIV infection diagnosed through routine HIV testing in these settings.
  
  
  METHODS
  Resource use data from four 2009/2010 Department of Health pilot studies (two ACUs; two GPs) were analysed. Data from the pilots were validated and supplemented with information from other sources. We constructed possible scenarios to estimate the cost per test carried out through expanded HIV testing in ACUs and GPs, and the cost per diagnosis.
  
  
  RESULTS
  In the pilots, cost per test ranged from £8.55 to £13.50, and offer time and patient uptake were 2 minutes and 90% in ACUs, and 5 minutes and 60% in GPs, respectively. In scenario analyses we fixed offer time, diagnostic test cost and uptake rate at 2 minutes, £6 and 80% for ACUs, and 5 minutes, £9.60 and 40% for GPs, respectively. The cost per new HIV diagnosis at a positivity of 2/1000 tests conducted was £3230 in ACUs and £7930 in GPs for tests performed by a Band 3 staff member, and £5940 in ACUs and £18 800 in GPs for tests performed by either hospital consultants or GPs.
  
  
  CONCLUSIONS
  Expanded HIV testing may be more cost-efficient in ACUs than in GPs as a consequence of a shorter offer time, higher patient uptake, higher HIV positivity and lower diagnostic test costs. As cost per new HIV diagnosis reduces at higher HIV positivity, expanded HIV testing should be promoted in high HIV prevalence areas.
authors.affiliation: Centre for Infectious Disease Surveillance and Control, Public Health England, UK.
authors.forename: K J
authors.initials: KJ
authors.lastname: Ong
authors.affiliation: Department of Infection and Population Health, University College London, London, UK.
authors.forename: A C
authors.initials: AC
authors.lastname: Thornton
authors.affiliation: Brighton and Sussex University Hospital, Brighton, UK.
authors.forename: M
authors.initials: M
authors.lastname: Fisher
authors.affiliation: NHS South East London, Public Health Lewisham, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Hutt
authors.affiliation: Brighton and Hove City Council, Brighton, UK.
authors.forename: S
authors.initials: S
authors.lastname: Nicholson
authors.affiliation: University Hospitals Leicester, Leicester, UK.
authors.forename: A
authors.initials: A
authors.lastname: Palfreeman
authors.affiliation: Brighton and Sussex University Hospital, Brighton, UK.
authors.forename: N
authors.initials: N
authors.lastname: Perry
authors.affiliation: Pamoja Consulting, Brighton, UK.
authors.forename: G
authors.initials: G
authors.lastname: Stedman-Bryce
authors.affiliation: Brighton and Hove City Council, Brighton, UK.
authors.forename: P
authors.initials: P
authors.lastname: Wilkinson
authors.affiliation: Centre for Infectious Disease Surveillance and Control, Public Health England, UK.
authors.forename: V
authors.initials: V
authors.lastname: Delpech
authors.affiliation: Centre for Infectious Disease Surveillance and Control, Public Health England, UK.
authors.forename: A
authors.initials: A
authors.lastname: Nardone
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis / Q000379:methods*; D003955:Diagnostic Tests, Routine / Q000191:economics*; D004739:England; D058006:General Practice / Q000706:statistics & numerical data; D015658:HIV Infections / Q000175:diagnosis*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008403:Mass Screening / Q000191:economics; D008875:Middle Aged; D010865:Pilot Projects; D055815:Young Adult
keywords: HIV testing; acute general medical admission(s); cost efficiency; general practice(s); hospitals