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Expanding HIV screening cost-effective measure to reduce spread
Long EF. Ann Intern Med. 2010;153:778-789.
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Screening people at high-risk for HIV annually and those at low-risk once in their lifetimes could prevent as many as 212,000 new HIV infections during the next 20 years, according to a study by Stanford University School of Medicine researchers.
“We find that expanded screening and treatment could offer substantial health benefits, preventing 15% to 20% of new cases,” Elisa Long, PhD, said in a press release. “And the strategy of one-time screening of low-risk individuals and annual screening of high-risk individuals is cost-effective.”
Long, now an assistant professor of operations management at Yale University, began the study while a graduate student at Stanford and worked with other researchers to examine how the course of the HIV epidemic might change with a larger screening program involving screening or treatment or both.
The researchers used a national model and projected that 1.23 million people would become newly infected in the next 20 years if things remained as they are today. Some 74% of new infections would be among high-risk individuals, particularly men who have sex with men and IV drug users.
The researchers concluded that if all adults in the United States were screened annually, regardless of risk, the cost would exceed $750,000 per quality-adjusted life year (QALY) gained. But screening everyone in the general population just once, together with yearly screening of high-risk individuals, would have a cost of less than $25,000 per QALY gained.
Screening alone, however, would not be sufficient to stem the epidemic but would have to go hand in hand with treatment, the researchers said. If 75% of individuals identified as HIV-positive received access to therapy, the health outcomes would be improved, and the program provides better value at $22,000 per QALY gained, the researchers calculated.
That combination strategy could prevent an estimated 17.3% of new infections, or 212,000 new cases, the researchers found.
The National Institute on Drug Abuse and the NIH funded the study.
Disclosure: Dr. Long has no relevant financial disclosures.
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