Details:

Alternative Title:
PLoS One
Publisher's site:
http://dx.doi.org/10.1371/journal.pone.0081565
Personal Author:
Haukoos, Jason S. ; Campbell, Jonathan D. ; Conroy, Amy A. ; Hopkins, Emily ; Bucossi, Meggan M. ; ... More +
Haukoos, Jason S. ; Campbell, Jonathan D. ; Conroy, Amy A. ; Hopkins, Emily ; Bucossi, Meggan M. ; Sasson, Comilla ; Al-Tayyib, Alia A. ; Thrun, Mark W. ; Less -
Corporate Authors:
For the Denver ED HIV Opt-Out Study Group ;
Description:
Background The Centers for Disease Control and Prevention recommends nontargeted opt-out HIV screening in healthcare settings. Cost effectiveness is critical when considering potential screening methods. Our goal was to compare programmatic costs of nontargeted opt-out rapid HIV screening with physician-directed diagnostic rapid HIV testing in an urban emergency department (ED) as part of the Denver ED HIV Opt-Out Trial. Methods This was a prospective cohort study nested in a larger quasi-experiment. Over 16 months, nontargeted rapid HIV screening (intervention) and diagnostic rapid HIV testing (control) were alternated in 4-month time blocks. During the intervention phase, patients were offered HIV testing using an opt-out approach during registration; during the control phase, physicians used a diagnostic approach to offer HIV testing to patients. Each method was fully integrated into ED operations. Direct program costs were determined using the perspective of the ED. Time-motion methodology was used to estimate personnel activity costs. Costs per patient newly-diagnosed with HIV infection by intervention phase, and incremental cost effectiveness ratios were calculated. Results During the intervention phase, 28,043 eligible patients were included, 6,933 (25%) completed testing, and 15 (0.2%, 95% CI: 0.1%–0.4%) were newly-diagnosed with HIV infection. During the control phase, 29,925 eligible patients were included, 243 (0.8%) completed testing, and 4 (1.7%, 95% CI: 0.4%–4.2%) were newly-diagnosed with HIV infection. Total annualized costs for nontargeted screening were $148,997, whereas total annualized costs for diagnostic HIV testing were $31,355. The average costs per HIV diagnosis were $9,932 and $7,839, respectively. Nontargeted HIV screening identified 11 more HIV infections at an incremental cost of $10,693 per additional infection. Conclusions Compared to diagnostic testing, nontargeted HIV screening was more costly but identified more HIV infections. More effective and less costly testing strategies may be required to improve the identification of patients with undiagnosed HIV infection in the ED.
Subject:
[+]
Cohort Studies
Cost-Benefit Analysis
Emergency Service, Hospital
HIV Infections
Humans
Mass Screening
Prospective Studies
Research Article

Source:
PLoS One. 2013; 8(12).
Pubmed ID:
24391706
Pubmed Central ID:
PMC3877399
Document Type:
Journal Article ;
Funding:
K02HS017526/HS/AHRQ HHS/United States ; R01 AI106057/AI/NIAID NIH HHS/United States ; R01AI10605/AI/NIAID NIH HHS/United States ; U18PS000314/PS/NCHHSTP CDC HHS/United States ;
K02HS017526/HS/AHRQ HHS/United States ; R01 AI106057/AI/NIAID NIH HHS/United States ; R01AI10605/AI/NIAID NIH HHS/United States ; U18PS000314/PS/NCHHSTP CDC HHS/United States ; Less -
Place as Subject:
United States ;
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:aed0576c920eeb2a1b7e05af55921888db5cf7ac224ba71e00d9a6268f59595c
File Type:

Supporting Files

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