title: Novel emergency department registration kiosk for HIV screening is cost-effective.
abstract: High operating costs challenge sustainability of successful US emergency department (ED) HIV screening programs. Free-standing registration kiosks could potentially reduce the marginal costs of ED HIV screening. We investigated incremental cost-effectiveness ratio (CER) per new HIV diagnosis for a kiosk-based approach for offering screening at ED registration versus a testing staff-based approach to offer testing at the bedside. A rapid oral-fluid HIV screening program, instituted in a US ED since 2005, had a rate of new HIV diagnosis 0.16% in 2012. A two-phase quasi experimental design, including a testing staff-based approach to offer testing at the bedside (Phase I, August and September 2011) and a kiosk-based approach to offer testing at ED registration (Phase II, December 2011 and January 2012), was performed. CER per new HIV diagnosis was defined as total cost of the screening program divided by number of newly diagnosed cases. Costs included screening program personnel (study coordinator, testing staff, and kiosk helpers), diagnostic assays (rapid and confirmatory tests), and kiosks (2 kiosks, software, and IT consulting fees). Sensitivity analyses were performed. Data from our dedicated testing staff (DTS) program (Phase I) resulted in an estimated 5434 patients tested in one year and 9 newly diagnosed HIV-infected patients (95% CI: 3, 18). Data from the kiosk program (Phase II), resulted in a projected 4571 ED patients tested in one year and 21 newly diagnosed HIV-infected patients (95% CI: 4, 70). The overall cost was $ 201,433 for the DTS program, versus $292,008 for the kiosk program. Incremental CER per new HIV diagnosis for kiosk-based approach was $7523 (range: $1780-90,025 by sensitivity analysis). Our pilot data demonstrated that the use of kiosks for HIV screening was potentially more cost-effective than a testing staff-based bedside approach.
authors.affiliation: a Department of Emergency Medicine, School of Medicine , The Johns Hopkins University , Baltimore , MD , USA.
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Hsieh
authors.affiliation: b Department of Health, Behavior, and Society, Bloomberg School of Public Health , The Johns Hopkins University , Baltimore , MD , USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Holtgrave
authors.affiliation: a Department of Emergency Medicine, School of Medicine , The Johns Hopkins University , Baltimore , MD , USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Peterson
authors.affiliation: a Department of Emergency Medicine, School of Medicine , The Johns Hopkins University , Baltimore , MD , USA.|c Division of Infectious Diseases, Department of Medicine , School of Medicine, The Johns Hopkins University , Baltimore , MD , USA.
authors.forename: Charlotte A
authors.initials: CA
authors.lastname: Gaydos
authors.affiliation: a Department of Emergency Medicine, School of Medicine , The Johns Hopkins University , Baltimore , MD , USA.|c Division of Infectious Diseases, Department of Medicine , School of Medicine, The Johns Hopkins University , Baltimore , MD , USA.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Rothman
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000191:economics*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000191:economics; D008875:Middle Aged; D019095:Point-of-Care Systems / Q000191:economics*; D012680:Sensitivity and Specificity
keywords: Emergency department; HIV; cost-effective; kiosk; screening