Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy

Gillian D. Sanders, Ahmed M. Bayoumi, Vandana Sundaram, S. Pinar Bilir, Christopher P. Neukermans, Chara Rydzak, Lena R. Douglass, Laura C. Lazzeroni, Mark Holodniy, Douglas K. Owens

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: The costs, benefits, and cost-effectiveness of screening for human immunodeficiency virus (HIV) in health care settings during the era of highly active antiretroviral therapy (HAART) have not been determined. METHODS: We developed a Markov model of costs, quality of life, and survival associated with an HIV-screening program as compared with current practice. In both strategies, symptomatic patients were identified through symptom-based case finding. Identified patients started treatment when their CD4 count dropped to 350 cells per cubic millimeter. Disease progression was defined on the basis of CD4 levels and viral load. The likelihood of sexual transmission was based on viral load, knowledge of HIV status, and efficacy of counseling. RESULTS: Given a 1 percent prevalence of unidentified HIV infection, screening increased life expectancy by 5.48 days, or 4.70 quality-adjusted days, at an estimated cost of $194 per screened patient, for a cost-effectiveness ratio of $15,078 per quality-adjusted life-year. Screening cost less than $50,000 per quality-adjusted life-year if the prevalence of unidentified HIV infection exceeded 0.05 percent. Excluding HIV transmission, the cost-effectiveness of screening was $41,736 per quality-adjusted life-year. Screening every five years, as compared with a one-time screening program, cost $57,138 per quality-adjusted life-year, but was more attractive in settings with a high incidence of infection. Our results were sensitive to the efficacy of behavior modification, the benefit of early identification and therapy, and the prevalence and incidence of HIV infection. CONCLUSIONS: The cost-effectiveness of routine HIV screening in health care settings, even in relatively low-prevalence populations, is similar to that of commonly accepted interventions, and such programs should be expanded.

Original languageEnglish (US)
Pages (from-to)570-585
Number of pages16
JournalNew England Journal of Medicine
Volume352
Issue number6
DOIs
StatePublished - Feb 10 2005
Externally publishedYes

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Highly Active Antiretroviral Therapy
Cost-Benefit Analysis
HIV
Quality-Adjusted Life Years
Virus Diseases
Costs and Cost Analysis
Viral Load
Delivery of Health Care
Behavior Therapy
Incidence
CD4 Lymphocyte Count
Secondary Prevention
Life Expectancy
Disease Progression
Counseling
Quality of Life
Survival
Infection
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Sanders, G. D., Bayoumi, A. M., Sundaram, V., Bilir, S. P., Neukermans, C. P., Rydzak, C., ... Owens, D. K. (2005). Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy. New England Journal of Medicine, 352(6), 570-585. https://doi.org/10.1056/NEJMsa042657

Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy. / Sanders, Gillian D.; Bayoumi, Ahmed M.; Sundaram, Vandana; Bilir, S. Pinar; Neukermans, Christopher P.; Rydzak, Chara; Douglass, Lena R.; Lazzeroni, Laura C.; Holodniy, Mark; Owens, Douglas K.

In: New England Journal of Medicine, Vol. 352, No. 6, 10.02.2005, p. 570-585.

Research output: Contribution to journalArticle

Sanders, GD, Bayoumi, AM, Sundaram, V, Bilir, SP, Neukermans, CP, Rydzak, C, Douglass, LR, Lazzeroni, LC, Holodniy, M & Owens, DK 2005, 'Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy', New England Journal of Medicine, vol. 352, no. 6, pp. 570-585. https://doi.org/10.1056/NEJMsa042657
Sanders, Gillian D. ; Bayoumi, Ahmed M. ; Sundaram, Vandana ; Bilir, S. Pinar ; Neukermans, Christopher P. ; Rydzak, Chara ; Douglass, Lena R. ; Lazzeroni, Laura C. ; Holodniy, Mark ; Owens, Douglas K. / Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy. In: New England Journal of Medicine. 2005 ; Vol. 352, No. 6. pp. 570-585.
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AU - Neukermans, Christopher P.

AU - Rydzak, Chara

AU - Douglass, Lena R.

AU - Lazzeroni, Laura C.

AU - Holodniy, Mark

AU - Owens, Douglas K.

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N2 - BACKGROUND: The costs, benefits, and cost-effectiveness of screening for human immunodeficiency virus (HIV) in health care settings during the era of highly active antiretroviral therapy (HAART) have not been determined. METHODS: We developed a Markov model of costs, quality of life, and survival associated with an HIV-screening program as compared with current practice. In both strategies, symptomatic patients were identified through symptom-based case finding. Identified patients started treatment when their CD4 count dropped to 350 cells per cubic millimeter. Disease progression was defined on the basis of CD4 levels and viral load. The likelihood of sexual transmission was based on viral load, knowledge of HIV status, and efficacy of counseling. RESULTS: Given a 1 percent prevalence of unidentified HIV infection, screening increased life expectancy by 5.48 days, or 4.70 quality-adjusted days, at an estimated cost of $194 per screened patient, for a cost-effectiveness ratio of $15,078 per quality-adjusted life-year. Screening cost less than $50,000 per quality-adjusted life-year if the prevalence of unidentified HIV infection exceeded 0.05 percent. Excluding HIV transmission, the cost-effectiveness of screening was $41,736 per quality-adjusted life-year. Screening every five years, as compared with a one-time screening program, cost $57,138 per quality-adjusted life-year, but was more attractive in settings with a high incidence of infection. Our results were sensitive to the efficacy of behavior modification, the benefit of early identification and therapy, and the prevalence and incidence of HIV infection. CONCLUSIONS: The cost-effectiveness of routine HIV screening in health care settings, even in relatively low-prevalence populations, is similar to that of commonly accepted interventions, and such programs should be expanded.

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