TY - JOUR
T1 - The Cost-effectiveness of HIV Testing of Physicians and Dentists in the United States
AU - Phillips, Kathryn A.
AU - Lowe, Robert A.
AU - Kahn, James G.
AU - Lurie, Peter
AU - Avins, Andrew L.
AU - Ciccarone, Daniel
N1 - Copyright:
Copyright 2015 Elsevier B.V., All rights reserved.
PY - 1994/3/16
Y1 - 1994/3/16
N2 - To evaluate the cost-effectiveness of alternative policies for human immunodeficiency testing (HIV) testing of physicians and dentists. Decision analysis and cost-effectiveness analysis from a societal perspective were used. Data were derived from extensive literature review and consultation with experts. We conducted sensitivity analyses and also performed a cost-benefit analysis. We analyzed policies for mandatory or voluntary testing of all physicians, surgeons, and dentists; for those testing positive, we analyzed mandatory or voluntary exclusion from practice, restriction from performance of invasive procedures, or requirements to inform patients of serostatus. Cost per patient infection averted. Although one-time mandatory testing of surgeons and dentists with mandatory restriction of those found to be HIV-positive is more cost-effective than other policies, the cost-effectiveness varies tremendously under different scenarios. Results were highly sensitive to several data inputs, especially HIV seroprevalence of surgeons and dentists and transmission risk. For example, under a medium seroprevalence and transmission risk scenario, mandatory testing of all surgeons might avert 25 infections at a total cost of 27.9 million or 1 115000 per infection averted and an incremental cost of 291000 compared with current testing; however, the incremental cost-effectiveness per patient infection averted ranges from 29 807000 under a low-risk scenario to a savings of 81 000 under a high-risk scenario. Our analysis neither justifies nor precludes a mandatory testing policy. Further research on the key data inputs is needed. Given the ethical, social, and public health implications, mandatory testing policies should not be implemented without greater certainty as to their cost-effectiveness.
AB - To evaluate the cost-effectiveness of alternative policies for human immunodeficiency testing (HIV) testing of physicians and dentists. Decision analysis and cost-effectiveness analysis from a societal perspective were used. Data were derived from extensive literature review and consultation with experts. We conducted sensitivity analyses and also performed a cost-benefit analysis. We analyzed policies for mandatory or voluntary testing of all physicians, surgeons, and dentists; for those testing positive, we analyzed mandatory or voluntary exclusion from practice, restriction from performance of invasive procedures, or requirements to inform patients of serostatus. Cost per patient infection averted. Although one-time mandatory testing of surgeons and dentists with mandatory restriction of those found to be HIV-positive is more cost-effective than other policies, the cost-effectiveness varies tremendously under different scenarios. Results were highly sensitive to several data inputs, especially HIV seroprevalence of surgeons and dentists and transmission risk. For example, under a medium seroprevalence and transmission risk scenario, mandatory testing of all surgeons might avert 25 infections at a total cost of 27.9 million or 1 115000 per infection averted and an incremental cost of 291000 compared with current testing; however, the incremental cost-effectiveness per patient infection averted ranges from 29 807000 under a low-risk scenario to a savings of 81 000 under a high-risk scenario. Our analysis neither justifies nor precludes a mandatory testing policy. Further research on the key data inputs is needed. Given the ethical, social, and public health implications, mandatory testing policies should not be implemented without greater certainty as to their cost-effectiveness.
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U2 - 10.1001/jama.1994.03510350061038
DO - 10.1001/jama.1994.03510350061038
M3 - Article
C2 - 8114240
AN - SCOPUS:0028330102
SN - 0098-7484
VL - 271
SP - 851
EP - 858
JO - JAMA: The Journal of the American Medical Association
JF - JAMA: The Journal of the American Medical Association
IS - 11
ER -