AIDS and Behavior

, Volume 21, Issue 3, pp 619–625 | Cite as

Cost-utility of HIV Testing Programs Among Men Who Have Sex with Men in the United States

  • Rose ZulligerEmail author
  • Cathy Maulsby
  • Liza Solomon
  • Chanza Baytop
  • Alex Orr
  • Muazzam Nasrullah
  • Luke Shouse
  • Elizabeth DiNenno
  • David Holtgrave
Original Article


Few groups in the United States (US) are as heavily affected by HIV as men who have sex with men (MSM), yet many MSM remain unaware of their infection. HIV diagnosis is important for decreasing onward transmission and promoting effective treatment for HIV, but the cost-effectiveness of testing programs is not well-established. This study reports on the costs and cost-utility of the MSM Testing Initiative (MTI) to newly diagnose HIV among MSM and link them to medical care. Cost and testing data in 15 US cities from January 2013 to March 2014 were prospectively collected and combined to determine the cost-utility of MTI in each city in terms of the cost per Quality Adjusted Life Years (QALY) saved from payer and societal perspectives. The total venue-based HIV testing costs ranged from $18,759 to $564,284 for nine to fifteen months of MTI implementation. The cost-saving threshold for HIV testing of MSM was $20,645 per new HIV diagnosis. Overall, 27,475 men were tested through venue-based MTI, of whom 807 (3 %) were newly diagnosed with HIV. These new diagnoses were associated with approximately 47 averted HIV infections. The cost per QALY saved by implementation of MTI in each city was negative, indicating that MTI venue-based testing was cost-saving in all cities. The cost-utility of social network and couples testing strategies was, however, dependent on whether the programs newly diagnosed MSM. The cost per new HIV diagnosis varied considerably across cities and was influenced by both the local cost of MSM testing implementation and by the seropositivity rate of those reached by the HIV testing program. While the cost-saving threshold for HIV testing is highly achievable, testing programs must successfully reach undiagnosed HIV-positive individuals in order to be cost-effective. This underscores the need for HIV testing programs which target and engage populations such as MSM who are most likely to have undiagnosed HIV to maximize programmatic benefit and cost-utility.


Men who have sex with men HIV testing Cost utility Economic evaluation 



This cost analysis was funded by Abt Associates grant number 112476.

Compliance with Ethical Standards

Conflict of Interest

Rose Zulliger, Cathy Maulsby, Liza Solomon, Chanza Baytop, Alex Orr, Muazzam Nasrullah, Luke Shouse, Elizabeth DiNenno, and David Holtgrave have no conflicts of interest to disclose.


The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention or the US Department of Health and Human Services.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Rose Zulliger
    • 1
    Email author
  • Cathy Maulsby
    • 1
  • Liza Solomon
    • 2
  • Chanza Baytop
    • 2
  • Alex Orr
    • 2
  • Muazzam Nasrullah
    • 3
  • Luke Shouse
    • 3
  • Elizabeth DiNenno
    • 3
  • David Holtgrave
    • 1
  1. 1.Department of Health, Behavior and SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Abt AssociatesBethesdaUSA
  3. 3.Centers for Disease Control and PreventionAtlantaUSA

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