The cost-effectiveness of expanded HIV screening in the United States

  • Lucas A
  • Armbruster B
  • A. L
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Abstract

Objective: The current Centers of Disease Control and Prevention (CDC) guidelines from 2006 recommend a one-time test for low-risk individuals and annual testing for those at high risk. These guidelines may not be aggressive enough, even for those at low risk of infection, due to the earlier initiation of HAART and a movement towards a testand- treat environment. We evaluated the optimal testing frequencies for various risk groups in comparison to the CDC recommendations. Methods: We build a deterministic mathematical model optimizing the tradeoff between the societal cost of testing and the benefits over a patient's lifetime of earlier diagnosis. Results: Under a test-and-treat scenario with immediate initiation of HAART, the optimal testing frequency is every 2.4 years for low-risk (0.01% annual incidence) individuals; every 9 months for moderate risk (0.1% incidence) individuals; and every 3 months for high-risk (1.0% incidence) individuals. The incremental cost-effectiveness of the optimal policy is $36 342/quality-adjusted life-years (QALY) for low-risk individuals and $45 074/QALY for high-risk individuals compared with 20-year and annual testing, respectively. Conclusion: The current CDC guidelines for HIV testing are too conservative, and more frequent testing is cost-effective for all risk groups. © 2013 Wolters Kluwer Health.

Author-supplied keywords

  • *Antiretroviral Therapy
  • *HIV Infections/ec [Economics]
  • *HIV test
  • *Human immunodeficiency virus infection/di [Diagno
  • *Human immunodeficiency virus infection/dt [Drug T
  • *Mass Screening/ec [Economics]
  • *cost effectiveness analysis
  • Cost-Benefit Analysis
  • HIV Infections/di [Diagnosis]
  • HIV Infections/dt [Drug Therapy]
  • Highly Active/mt [Methods]
  • Human immunodeficiency virus infection/dt [Drug Th
  • Humans
  • Mass Screening/mt [Methods]
  • Models
  • Practice Guidelines as Topic
  • Quality-Adjusted Life Years
  • Risk Factors
  • Theoretical
  • Time Factors
  • United States
  • anti human immunodeficiency virus agent/dt [Drug T
  • article
  • early diagnosis
  • health care cost
  • high risk population
  • highly active antiretroviral therapy
  • human
  • infection risk
  • low risk population
  • mathematical model
  • practice guideline
  • priority journal
  • public health service
  • quality of life
  • society

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Authors

  • Aaron Lucas

  • Benjamin Armbruster

  • Lucas A.

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