Clinical research studyRoutine human immunodeficiency virus testing: An economic evaluation of current guidelines
Section snippets
Study overview
We constructed an inpatient screening model (hereafter referred to as the “screening module”), building upon the foundation of a previously designed and published model of the natural history and treatment of HIV disease (hereafter referred to as the “disease model”).14, 15, 16 The purpose of the screening module is to simulate the detection of HIV infection in a general inpatient target group, with a specified prevalence of undetected HIV infection, whose members are offered routine voluntary
Base case
A routine inpatient HIV screening program increased projected, discounted life expectancy from 5602.56 to 6215.15 QALYs per 1000 HIV-infected patients, or approximately 7.35 quality-adjusted life-months per infected person (Table 2). At a 37% test acceptance rate, screening of 1000 uninfected patients on average cost $19,800, or approximately $20 per uninfected person. By advancing the time of identification with screening, the mean CD4 cell count at detection was increased from 196 to 244
Discussion
The 2001 CDC guidelines for HIV counseling, testing, and referral recommend routine screening of all inpatients in hospitals with an HIV prevalence of ≥1%.3 This threshold is largely based on a single-blinded HIV seroprevalence study of 20 acute care U.S. hospitals conducted by Janssen et al. in 1992.4 In that study, hospitals with AIDS diagnosis rates of >1/1000 discharges correlated to HIV seroprevalence rates of >1%. The authors estimated that a routine inpatient HIV screening program in
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Cited by (0)
This research was funded by the National Institute of Allergy and Infectious Diseases (K23AI01794, K24AI062476, K25AI50436, R01AI42006, Center for AIDS Research P30AI42851), the National Institute of Mental Health (R01MH65869), the National Institute on Drug Abuse (R01DA015612), and the Centers for Disease Control and Prevention (S1396-20/21).