Health Care Management Science

, Volume 9, Issue 2, pp 143–149 | Cite as

Optimal pooled testing



This paper first characterizes three pooled testing techniques for generic testing conditions. It then applies these methods to demonstrate potential costs savings for universal HIV screening in the United Stated and Thailand. The success of these techniques in general is shown to be dependent on the prevalence as well as the disparity in prevalence between high and low risk groups. Further limitations on effectiveness include the potential impact of dilution on sensitivity. This and other limitations are addressed in the second section which focuses on applications of the techniques. Cost reductions are demonstrated to be feasible at prevalence of up to 30% and increasing dramatically at lower rates. Applying optimal pooled testing to universal HIV screening would result in an annual savings of over $1.4 billion in the United States and over $130 million in Thailand. Recent calls for universal HIV testing are based on the cost effectiveness of routine screening. These assessments may substantially overstate the cost of routine screening which strengthens the argument for universal screening.


Pooled testing HIV screening Cost reduction 


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  1. 1.
    Paltiel DA, Weinstein MC, Kimmel AD, et al (2005) Expanding HIV screening in the United States—an analysis of cost-effectiveness. N Engl J Med 352:586–595CrossRefGoogle Scholar
  2. 2.
    Sanders GD, Bayoumi AM, Sundaram V, et al (2005) Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy. N Engl J Med 352:570–585CrossRefGoogle Scholar
  3. 3.
    Dorfman R (1943, Dec) The detection of defective members of large populations. Ann Math Stat 14(4):436 – 440Google Scholar
  4. 4.
    Wein Lawrence M, Zenios S.A. (1996) Pooled testing for HIV screening: capturing the dilution effect. Oper Res 44(4):543–569 (Jul–Aug)CrossRefGoogle Scholar
  5. 5.
    Tu XM, Litvak E, Pagano M (1994) Screening tests: can we get more by doing less? Stat Med 13:1905–1919Google Scholar
  6. 6.
    Behets F et al (1990, Aug) Successful use of pooled sera to determine HIV-1 seroprevalence in Zaire with development of cost-efficiency models. AIDS 4(8):737–741Google Scholar
  7. 7.
    Raboud J et al (1993, Sept) Combining pooling and alternative algorithms in seroprevalence studies. J Clin Microbiol 2298–2302Google Scholar
  8. 8.
    Suthipong Treeratana M.D.. Interviews w. author 12/2003 and 6/2004Google Scholar
  9. 9.
    Monzon OT, Paladin FJ, Dimaandal E, Balis AM, Samson C, Mitchell S (1992, Jan) Relevance of antibody content and test format in HIV testing of pooled sera. AIDS 6(1):43–48Google Scholar
  10. 10.
    Frosner GG, Dobler G, von Sonnenburg FJ (1990, Jan) Cost reduction of unlinked testing for anti-HIV by investigation of pooled sera. AIDS 4(1):73–75CrossRefGoogle Scholar
  11. 11.
    National Library of Medicine. Scholar
  12. 12.
    Bozzette Samuel A (2005) Routine screening for HIV infection—timely and cost effective. N Engl J Med 352:620–621CrossRefGoogle Scholar
  13. 13.
    National Center for HIV, STD and TB Prevention, Divisions of HIV/AIDS Prevention, Basic Statistics, Dec 20, 2004. (accessed 2/23/2005 at Scholar
  14. 14.
    Laumann E.O, Gagnon J.H, Michael R.T, Stuart Michaels (1994) The social organization of sex: sexual practices in the United States. University of ChicagoGoogle Scholar

Copyright information

© Springer Science + Business Media, Inc. 2006

Authors and Affiliations

  1. 1.Economics and Quantitative MethodsHawaii Pacific UniversityHonoluluUSA
  2. 2.Managerial Economics and Decision SciencesNorthwestern UniversityEvanstonUSA

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