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Routine human immunodeficiency virus testing: an economic evaluation of current guidelines
Rochelle P Walensky1, Milton C Weinstein, April D Kimmel
1Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, and the Partners AIDS Research Center, Harvard Medical School, Boston, Massachusetts 02114, USA. rwalensky@partners.org
The American Journal of Medicine
|March 5, 2005
Summary
Routine HIV screening in hospitals is cost-effective, even at lower prevalence rates. Implementing current guidelines can link infected patients to life-sustaining care, improving health outcomes.
Area of Science:
- Public Health
- Health Economics
- Infectious Disease Epidemiology
Background:
- Current CDC guidelines recommend HIV screening for hospital patients with >=1% prevalence.
- This 1% threshold has not been re-evaluated since HIV became effectively treatable in 1995.
- The study aims to assess the clinical and economic impact of current and alternative HIV screening thresholds.
Purpose of the Study:
- To evaluate the cost-effectiveness of current HIV screening guidelines.
- To analyze the impact of alternative HIV prevalence thresholds for screening.
- To determine the clinical effectiveness of expanded HIV screening programs.
Main Methods:
- A cost-effectiveness analysis was conducted.
- A computer simulation model of HIV screening and disease in US hospital inpatients was utilized.
Main Results:
- HIV screening at 1% prevalence increased life expectancy by 6.13 years per 1000 inpatients at $35,400/QALY.
- Screening at 0.1% prevalence yielded a ratio of $64,500/QALY.
- Increased testing costs to $103 still resulted in a cost-effectiveness ratio below $100,000/QALY at 0.1% prevalence.
Conclusions:
- Routine inpatient HIV screening is cost-effective and remains so at 10x lower prevalence.
- Current HIV counseling, testing, and referral guidelines should be implemented nationwide.
- These programs effectively link infected patients to essential, life-sustaining care.