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

Publication ,  Journal Article
Sanders, GD; Bayoumi, AM; Sundaram, V; Bilir, SP; Neukermans, CP; Rydzak, CE; Douglass, LR; Lazzeroni, LC; Holodniy, M; Owens, DK
Published in: N Engl J Med
February 10, 2005

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 dollars per screened patient, for a cost-effectiveness ratio of 15,078 dollars per quality-adjusted life-year. Screening cost less than 50,000 dollars 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 dollars per quality-adjusted life-year. Screening every five years, as compared with a one-time screening program, cost 57,138 dollars 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.

Duke Scholars

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Published In

N Engl J Med

DOI

EISSN

1533-4406

Publication Date

February 10, 2005

Volume

352

Issue

6

Start / End Page

570 / 585

Location

United States

Related Subject Headings

  • Risk Factors
  • Quality-Adjusted Life Years
  • Quality of Life
  • Prevalence
  • Mass Screening
  • Markov Chains
  • Male
  • Life Expectancy
  • Humans
  • Health Care Costs
 

Citation

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Sanders, G. D., Bayoumi, A. M., Sundaram, V., Bilir, S. P., Neukermans, C. P., Rydzak, C. E., … Owens, D. K. (2005). Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy. N Engl J Med, 352(6), 570–585. https://doi.org/10.1056/NEJMsa042657
Sanders, Gillian D., Ahmed M. Bayoumi, Vandana Sundaram, S Pinar Bilir, Christopher P. Neukermans, Chara E. Rydzak, Lena R. Douglass, Laura C. Lazzeroni, Mark Holodniy, and Douglas K. Owens. “Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy.N Engl J Med 352, no. 6 (February 10, 2005): 570–85. https://doi.org/10.1056/NEJMsa042657.
Sanders GD, Bayoumi AM, Sundaram V, Bilir SP, Neukermans CP, Rydzak CE, et al. Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy. N Engl J Med. 2005 Feb 10;352(6):570–85.
Sanders, Gillian D., et al. “Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy.N Engl J Med, vol. 352, no. 6, Feb. 2005, pp. 570–85. Pubmed, doi:10.1056/NEJMsa042657.
Sanders GD, Bayoumi AM, Sundaram V, Bilir SP, Neukermans CP, Rydzak CE, Douglass LR, Lazzeroni LC, Holodniy M, Owens DK. Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy. N Engl J Med. 2005 Feb 10;352(6):570–585.

Published In

N Engl J Med

DOI

EISSN

1533-4406

Publication Date

February 10, 2005

Volume

352

Issue

6

Start / End Page

570 / 585

Location

United States

Related Subject Headings

  • Risk Factors
  • Quality-Adjusted Life Years
  • Quality of Life
  • Prevalence
  • Mass Screening
  • Markov Chains
  • Male
  • Life Expectancy
  • Humans
  • Health Care Costs