The cost-effectiveness of voluntary counseling and testing of hospital inpatients for HIV infection

Peter Lurie, Andrew L. Avins, Kathryn A. Phillips, James G. Kahn, Robert A. Lowe, Robert (Bob) Lowe

Research output: Contribution to journalArticle

28 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)1832-1838
Number of pages7
JournalJournal of the American Medical Association
Volume272
Issue number23
DOIs
StatePublished - Dec 21 1994
Externally publishedYes

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Virus Diseases
Cost-Benefit Analysis
Counseling
Inpatients
HIV
Seroepidemiologic Studies
Costs and Cost Analysis
Social Discrimination
Infection
Delivery of Health Care
HIV-2
Decision Support Techniques
Information Storage and Retrieval
Advisory Committees
Informed Consent
Health Care Costs
Consensus
Referral and Consultation

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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 journalArticle

Lurie, Peter ; Avins, Andrew L. ; Phillips, Kathryn A. ; Kahn, James G. ; Lowe, Robert A. ; Lowe, Robert (Bob). / The cost-effectiveness of voluntary counseling and testing of hospital inpatients for HIV infection. In: Journal of the American Medical Association. 1994 ; Vol. 272, No. 23. pp. 1832-1838.
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