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Preoperative HIV testing: is it less expensive than universal precautions?

V A Lawrence¹, A Gafni, K Kroenke

¹Department of Medicine, University of Texas Health Science Center at San Antonio 78284-7879.

Journal of Clinical Epidemiology

|November 1, 1993

Summary

Routine preoperative HIV testing is not more cost-effective than universal precautions for elective surgery. Universal precautions are recommended to prevent HIV transmission, despite higher costs, as routine testing is more expensive.

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Area of Science:

Public Health
Health Economics
Infectious Disease Prevention

Background:

Universal precautions (UP) are recommended for preventing HIV transmission in healthcare settings.
Routine preoperative HIV testing (RT) is proposed as a cost-saving alternative for elective surgery.
Current strategies lack clinical trial validation and UP are considered expensive.

Purpose of the Study:

To compare the economic viability of routine preoperative HIV testing versus universal precautions for elective surgery.
To determine if routine testing offers a cost-effective alternative to universal precautions.
To evaluate the cost-effectiveness of HIV prevention strategies in surgical settings.

Main Methods:

An economic evaluation comparing routine testing (RT) and universal precautions (UP).

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A simplified approach to estimate costs per elective operation, assuming equal effectiveness in preventing HIV transmission.

Minimized cost estimates for RT and maximized cost estimates for UP were compared.

Main Results:

The minimized average cost of routine testing (US$57) exceeded the maximized average cost of universal precautions (US$36) per procedure.
Sensitivity analysis confirmed the robustness of these findings.
Routine HIV testing was found not to be a valid economic alternative to universal precautions.

Conclusions:

Routine preoperative HIV testing is not economically advantageous compared to universal precautions for elective surgery.
The study highlights the need for rigorous economic evaluations of HIV prevention strategies.
A simple methodology was employed, useful for preliminary reviews when detailed data is scarce.