title: Costs of Expanded Rapid HIV Testing in Four Emergency Departments.
abstract: OBJECTIVE
  The HIV Prevention Trials Network (HPTN) 065 trial sought to expand HIV screening of emergency department (ED) patients in Bronx, New York, and Washington, D.C. This study assessed the testing costs associated with different expansion processes and compared them with costs of a hypothetical optimized process.
  
  
  METHODS
  Micro-costing studies were conducted in two participating EDs in each city that switched from point-of-care (POC) to rapid-result laboratory testing. In three EDs, laboratory HIV testing was only conducted for patients having blood drawn for clinical reasons; in the other ED, all HIV testing was conducted with laboratory testing. Costs were estimated through direct observation and interviews to document process flows, time estimates, and labor and materials costs. A hypothetical optimized process flow used minimum time estimates for each process step. National wage and fringe rates and local reagent costs were used to determine the average cost (excluding overhead) per completed nonreactive and reactive test in 2013 U.S. dollars.
  
  
  RESULTS
  Laboratory HIV testing costs in the EDs ranged from $17.00 to $23.83 per completed nonreactive test, and POC testing costs ranged from $17.64 to $37.60; cost per completed reactive test ranged from $89.29 to $123.17. Costs of hypothetical optimized HIV testing with automated process steps were approximately 45% lower for nonreactive tests and 20% lower for reactive tests. The cost per ED visit to conduct expanded HIV testing in each hospital ranged from $1.21 to $3.96.
  
  
  CONCLUSIONS
  An optimized process could achieve additional cost savings but would require an investment in electronic system interfaces to further automate testing processes.
authors: Weill Cornell Medical College, Department of Healthcare Policy and Research, New York, NY.
authors: Bruce R
authors: BR
authors: Schackman
authors: Weill Cornell Medical College, Department of Healthcare Policy and Research, New York, NY.
authors: Ashley A
authors: AA
authors: Eggman
authors: Weill Cornell Medical College, Department of Healthcare Policy and Research, New York, NY.
authors: Jared A
authors: JA
authors: Leff
authors: Weill Cornell Medical College, Department of Healthcare Policy and Research, New York, NY.
authors: Megan
authors: M
authors: Braunlin
authors: Montefiore Medical Center, Division of Infectious Diseases, Bronx, NY.
authors: Uriel R
authors: UR
authors: Felsen
authors: United Medical Center, The Care Center, Washington, DC.
authors: Lisa
authors: L
authors: Fitzpatrick
authors: Bronx Lebanon Hospital Center, Bronx, NY.
authors: Edward E
authors: EE
authors: Telzak
authors: Columbia University, Mailman School of Public Health, International Center for AIDS Care and Treatment Programs, New York, NY.
authors: Wafaa
authors: W
authors: El-Sadr
authors: Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA.
authors: Bernard M
authors: BM
authors: Branson
mesh_terms: D015492:AIDS Serodiagnosis / Q000191:economics* / Q000379:methods; D004219:District of Columbia; D017598:Efficiency, Organizational / Q000191:economics; D004636:Emergency Service, Hospital / Q000191:economics*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D009519:New York City