Abstract
Objective. - To evaluate the cost-effectiveness of voluntary counseling and testing of US hospital inpatients for the human immunodeficiency virus (HIV). Data Sources. - Data for entry into the model were derived from a review of the literature, consultation with experts, and consensus of the authors. Data Extraction. - We rated our confidence in these probabilities and costs by grading the data inputs using methods adapted from those of the US Preventive Services Task Force. Data Synthesis. - Decision analysis models were developed to evaluate two outcomes: (1) cost per health care worker (HCW) HIV infection averted if measures are taken by the HCW to reduce his or her risk of acquiring HIV; and (2) cost per inpatient HIV infection detected. Sensitivity analyses were also conducted. Using baseline input values, testing to avert HCW infection may prevent 3.6 HIV infections per year at a total program cost of $2.7 billion, or a cost of $753 million per infection averted. At baseline assumptions (seroprevalence=1%), testing to detect inpatient HIV infection would cost $16 104 per year per infection detected. Cost-effectiveness at baseline drops to $8353 per HIV infection detected if the seroprevalence is 10%. If testing is limited to hospitals with inpatient seroprevalences of at least 1%, approximately 5400 persons per year will be falsely labeled HIV-positive. Conclusions. - This analysis provides no justification for testing inpatients to prevent HIV infection of HCWs. Screening inpatients to detect HIV infection may be justified at seroprevalences exceeding 1%, but issues of medical or social discrimination, false-positive results, informed consent, and logistics must be resolved first.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1832-1838 |
| Number of pages | 7 |
| Journal | Journal of the American Medical Association |
| Volume | 272 |
| Issue number | 23 |
| DOIs | |
| State | Published - Dec 21 1994 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Medicine(all)
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The cost-effectiveness of voluntary counseling and testing of hospital inpatients for HIV infection. / Lurie, Peter; Avins, Andrew L.; Phillips, Kathryn A.; Kahn, James G.; Lowe, Robert A.; Lowe, Robert (Bob).
In: Journal of the American Medical Association, Vol. 272, No. 23, 21.12.1994, p. 1832-1838.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The cost-effectiveness of voluntary counseling and testing of hospital inpatients for HIV infection
AU - Lurie, Peter
AU - Avins, Andrew L.
AU - Phillips, Kathryn A.
AU - Kahn, James G.
AU - Lowe, Robert A.
AU - Lowe, Robert (Bob)
PY - 1994/12/21
Y1 - 1994/12/21
N2 - Objective. - To evaluate the cost-effectiveness of voluntary counseling and testing of US hospital inpatients for the human immunodeficiency virus (HIV). Data Sources. - Data for entry into the model were derived from a review of the literature, consultation with experts, and consensus of the authors. Data Extraction. - We rated our confidence in these probabilities and costs by grading the data inputs using methods adapted from those of the US Preventive Services Task Force. Data Synthesis. - Decision analysis models were developed to evaluate two outcomes: (1) cost per health care worker (HCW) HIV infection averted if measures are taken by the HCW to reduce his or her risk of acquiring HIV; and (2) cost per inpatient HIV infection detected. Sensitivity analyses were also conducted. Using baseline input values, testing to avert HCW infection may prevent 3.6 HIV infections per year at a total program cost of $2.7 billion, or a cost of $753 million per infection averted. At baseline assumptions (seroprevalence=1%), testing to detect inpatient HIV infection would cost $16 104 per year per infection detected. Cost-effectiveness at baseline drops to $8353 per HIV infection detected if the seroprevalence is 10%. If testing is limited to hospitals with inpatient seroprevalences of at least 1%, approximately 5400 persons per year will be falsely labeled HIV-positive. Conclusions. - This analysis provides no justification for testing inpatients to prevent HIV infection of HCWs. Screening inpatients to detect HIV infection may be justified at seroprevalences exceeding 1%, but issues of medical or social discrimination, false-positive results, informed consent, and logistics must be resolved first.
AB - Objective. - To evaluate the cost-effectiveness of voluntary counseling and testing of US hospital inpatients for the human immunodeficiency virus (HIV). Data Sources. - Data for entry into the model were derived from a review of the literature, consultation with experts, and consensus of the authors. Data Extraction. - We rated our confidence in these probabilities and costs by grading the data inputs using methods adapted from those of the US Preventive Services Task Force. Data Synthesis. - Decision analysis models were developed to evaluate two outcomes: (1) cost per health care worker (HCW) HIV infection averted if measures are taken by the HCW to reduce his or her risk of acquiring HIV; and (2) cost per inpatient HIV infection detected. Sensitivity analyses were also conducted. Using baseline input values, testing to avert HCW infection may prevent 3.6 HIV infections per year at a total program cost of $2.7 billion, or a cost of $753 million per infection averted. At baseline assumptions (seroprevalence=1%), testing to detect inpatient HIV infection would cost $16 104 per year per infection detected. Cost-effectiveness at baseline drops to $8353 per HIV infection detected if the seroprevalence is 10%. If testing is limited to hospitals with inpatient seroprevalences of at least 1%, approximately 5400 persons per year will be falsely labeled HIV-positive. Conclusions. - This analysis provides no justification for testing inpatients to prevent HIV infection of HCWs. Screening inpatients to detect HIV infection may be justified at seroprevalences exceeding 1%, but issues of medical or social discrimination, false-positive results, informed consent, and logistics must be resolved first.
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U2 - 10.1001/jama.272.23.1832
DO - 10.1001/jama.272.23.1832
M3 - Article
C2 - 7990217
AN - SCOPUS:0027993192
VL - 272
SP - 1832
EP - 1838
JO - JAMA - Journal of the American Medical Association
JF - JAMA - Journal of the American Medical Association
SN - 0002-9955
IS - 23
ER -