The cost-effectiveness of expanded HIV screening in the United StatesLucas, Aaron; Armbruster, BenjaminAIDS: 13 March 2013 - Volume 27 - Issue 5 - p 795–801 doi: 10.1097/QAD.0b013e32835c54f9 Epidemiology and Social Abstract Author Information Objective: The current Centers of Disease Control and Prevention (CDC) guidelines from 2006 recommend a one-time test for low-risk individuals and annual testing for those at high risk. These guidelines may not be aggressive enough, even for those at low risk of infection, due to the earlier initiation of HAART and a movement towards a test-and-treat environment. We evaluated the optimal testing frequencies for various risk groups in comparison to the CDC recommendations. Methods: We build a deterministic mathematical model optimizing the tradeoff between the societal cost of testing and the benefits over a patient's lifetime of earlier diagnosis. Results: Under a test-and-treat scenario with immediate initiation of HAART, the optimal testing frequency is every 2.4 years for low-risk (0.01% annual incidence) individuals; every 9 months for moderate risk (0.1% incidence) individuals; and every 3 months for high-risk (1.0% incidence) individuals. The incremental cost-effectiveness of the optimal policy is $36 342/quality-adjusted life-years (QALY) for low-risk individuals and $45 074/QALY for high-risk individuals compared with 20-year and annual testing, respectively. Conclusion: The current CDC guidelines for HIV testing are too conservative, and more frequent testing is cost-effective for all risk groups. Department of Industrial Engineering and Management Science, Northwestern University, Evanston, Illinois, USA. Correspondence to Aaron Lucas, Department of Industrial Engineering and Management Science, Northwestern University, Evanston, IL 60208, USA. Tel: +1 610 308 1471; e-mail: email@example.com Received 21 August, 2012 Revised 25 October, 2012 Accepted 6 November, 2012 Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://www.AIDSonline.com). © 2013 Lippincott Williams & Wilkins, Inc.