Cost-Effectiveness of Strategies to Improve HIV Testing and Receipt of Results: Economic Analysis of a Randomized Controlled Trial
- Gillian D. SandersAffiliated withDuke Clinical Research Institute, Duke University Email author
- , Henry D. AnayaAffiliated withVeterans Affairs (VA) Greater Los Angeles Healthcare SystemUCLA School of Medicine
- , Steven AschAffiliated withVeterans Affairs (VA) Greater Los Angeles Healthcare SystemUCLA School of MedicineRAND Health
- , Tuyen HoangAffiliated withVeterans Affairs (VA) Greater Los Angeles Healthcare System
- , Joya F. GoldenAffiliated withVeterans Affairs (VA) Greater Los Angeles Healthcare System
- , Ahmed M. BayoumiAffiliated withSt. Michael’s HospitalUniversity of Toronto
- , Douglas K. OwensAffiliated withVA Palo Alto Healthcare SystemStanford University
The CDC recommends routine voluntary HIV testing of all patients 13-64 years of age. Despite this recommendation, HIV testing rates are low even among those at identifiable risk, and many patients do not return to receive their results.
To examine the costs and benefits of strategies to improve HIV testing and receipt of results.
Cost-effectiveness analysis based on a Markov model. Acceptance of testing, return rates, and related costs were derived from a randomized trial of 251 patients; long-term costs and health outcomes were derived from the literature.
Primary-care patients with unknown HIV status.
Comparison of three intervention models for HIV counseling and testing: Model A = traditional HIV counseling and testing; Model B = nurse-initiated routine screening with traditional HIV testing and counseling; Model C = nurse-initiated routine screening with rapid HIV testing and streamlined counseling.
Life-years, quality-adjusted life-years (QALYs), costs and incremental cost-effectiveness.
Without consideration of the benefit from reduced HIV transmission, Model A resulted in per-patient lifetime discounted costs of $48,650 and benefits of 16.271 QALYs. Model B increased lifetime costs by $53 and benefits by 0.0013 QALYs (corresponding to 0.48 quality-adjusted life days). Model C cost $66 more than Model A with an increase of 0.0018 QALYs (0.66 quality-adjusted life days) and an incremental cost-effectiveness of $36,390/QALY. When we included the benefit from reduced HIV transmission, Model C cost $10,660/QALY relative to Model A. The cost-effectiveness of Model C was robust in sensitivity analyses.
In a primary-care population, nurse-initiated routine screening with rapid HIV testing and streamlined counseling increased rates of testing and receipt of test results and was cost-effective compared with traditional HIV testing strategies.
KEY WORDSHIV cost-benefit analysis highly active antiretroviral therapy transmission nurse-initiated HIV screening HIV rapid testing Streamlined counseling
- Cost-Effectiveness of Strategies to Improve HIV Testing and Receipt of Results: Economic Analysis of a Randomized Controlled Trial
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Journal of General Internal Medicine
Volume 25, Issue 6 , pp 556-563
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- cost-benefit analysis
- highly active antiretroviral therapy
- nurse-initiated HIV screening
- HIV rapid testing
- Streamlined counseling
- Industry Sectors
- Author Affiliations
- 1. Duke Clinical Research Institute, Duke University, PO Box 17969, Durham, NC, 27715, USA
- 2. Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- 3. UCLA School of Medicine, Los Angeles, CA, USA
- 4. RAND Health, Santa Monica, CA, USA
- 5. St. Michael’s Hospital, Toronto, ON, Canada
- 6. University of Toronto, Toronto, ON, Canada
- 7. VA Palo Alto Healthcare System, Palo Alto, CA, USA
- 8. Stanford University, Stanford, CA, USA