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Previous Volume 352:570-585 February 10, 2005 Number 6 Next

	Full Text PDF PDA Full Text Supplementary Material Editorial by Bozzette, S. A. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background The costs, benefits, and cost-effectiveness of screening for human immunodeficiency virus (HIV) in health care settings during the era of highly active antiretroviral therapy (HAART) have not been determined.

Methods We developed a Markov model of costs, quality of life, and survival associated with an HIV-screening program as compared with current practice. In both strategies, symptomatic patients were identified through symptom-based case finding. Identified patients started treatment when their CD4 count dropped to 350 cells per cubic millimeter. Disease progression was defined on the basis of CD4 levels and viral load. The likelihood of sexual transmission was based on viral load, knowledge of HIV status, and efficacy of counseling.

Results Given a 1 percent prevalence of unidentified HIV infection, screening increased life expectancy by 5.48 days, or 4.70 quality-adjusted days, at an estimated cost of $194 per screened patient, for a cost-effectiveness ratio of $15,078 per quality-adjusted life-year. Screening cost less than $50,000 per quality-adjusted life-year if the prevalence of unidentified HIV infection exceeded 0.05 percent. Excluding HIV transmission, the cost-effectiveness of screening was $41,736 per quality-adjusted life-year. Screening every five years, as compared with a one-time screening program, cost $57,138 per quality-adjusted life-year, but was more attractive in settings with a high incidence of infection. Our results were sensitive to the efficacy of behavior modification, the benefit of early identification and therapy, and the prevalence and incidence of HIV infection.

Conclusions The cost-effectiveness of routine HIV screening in health care settings, even in relatively low-prevalence populations, is similar to that of commonly accepted interventions, and such programs should be expanded.

Source Information

From Duke Clinical Research Institute, Duke University, Durham, N.C. (G.D.S.); the Center for Primary Care and Outcomes Research, Department of Medicine (G.D.S., V.S., S.P.B., C.P.N., C.E.R., D.K.O.), and the Department of Health Research and Policy (L.C.L., D.K.O.), School of Medicine (M.H.), Stanford University, Stanford, Calif.; the Centre for Research on Inner City Health and Division of General Medicine, St. Michael's Hospital, and the Department of Medicine, University of Toronto — both in Toronto (A.M.B.); and Palo Alto Veterans Affairs Health Care System, Palo Alto, Calif. (V.S., L.R.D., M.H., D.K.O.).

Address reprint requests to Dr. Sanders at Duke Clinical Research Institute, P.O. Box 17969, Duke University, Durham, NC 27715, or at gillian.sanders{at}duke.edu.

Full Text of this Article

Related Letters:

Cost-Effectiveness of Screening for HIV
Taiwo B. O., Thrasher A. D., Ford C. L., Nearing K. A., da Silveira E., Sanders G. D., Bayoumi A. M., Owens D. K., Paltiel A. D., Walensky R. P., Freedberg K. A.
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N Engl J Med 2005; 352:2137-2139, May 19, 2005. Correspondence

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