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The cost-effectiveness of expanded HIV screening in the United States

Lucas, Aaron; Armbruster, Benjamin

doi: 10.1097/QAD.0b013e32835c54f9
Epidemiology and Social

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: aalucas@u.northwestern.edu

Received 21 August, 2012

Revised 25 October, 2012

Accepted 6 November, 2012

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© 2013 Lippincott Williams & Wilkins, Inc.