Emergency department management of occupational exposures: cost analysis of rapid HIV test

To compare costs for evaluation and treatment of a healthcare worker (HCW) experiencing an occupational exposure, using a rapid human immunodeficiency virus (HIV) test versus a standard enzyme-linked immunosorbent assay (ELISA) HIV test.

Retrospective chart review of all HCWs presenting to the emergency department (ED) for care of an occupational exposure over a 13-month period.

A 404-bed university-based level 1 trauma center with an annual ED census of approximately 35,000.

All HCWs experiencing an occupational exposure treated in the ED using a rapid HIV protocol were included in the analysis.

A calculation of selected costs of the initial evaluation and treatment of patients whose evaluation included a rapid HIV test on the source patient were performed. A similar calculation was then made for these patients, had the standard ELISA test been used. Evaluated costs included laboratory tests, postexposure prophylactic medications, and estimated lost work time. Other costs were constant and were not included in the evaluation.

Total evaluated cost using the rapid HIV test as part of the evaluation and treatment protocol was $465.80 for 17 patients. Had the ELISA test been used instead of the rapid test, the total evaluated cost for the 17 patients would have been $5,965.81.

When used as part of the evaluation and treatment of the HCW with an occupational exposure, the rapid HIV test results in substantial cost savings over the ELISA test .