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A budget impact analysis of rapid human immunodeficiency virus screening in Veterans Administration emergency departments
Women’s Health Research Faculty Publications
  • Risha Gidwani, University of California - Los Angeles
  • Matthew Bidwell Goetz, University of California - Los Angeles
  • Gerald Kominski, University of California - Los Angeles
  • Steven Asch, University of California - Los Angeles
  • Kristin M Mattocks, University of Massachusetts Medical School Worcester
  • Jeffrey H. Samet, Boston University
  • Amy Justice, Yale University
  • Neel Gandhi, Albert Einstein College of Medicine
  • Jack Needleman, University of California - Los Angeles
UMMS Affiliation
Department of Quantitative Health Sciences
Publication Date
Document Type
*AIDS Serodiagnosis; Emergency Service, Hospital; HIV Infections; Health Care Costs; Hospitals, Veterans; Humans; Mass Screening

BACKGROUND: Human immunodeficiency virus (HIV) screening is cost-effective and recommended in populations with low disease prevalence. However, because screening is not cost-saving, its financial feasibility must be understood. STUDY OBJECTIVES: We forecast the costs of two Emergency Department-based HIV testing programs in the Veterans Administration: 1) implementing a non-targeted screening program and providing treatment for all patients thusly identified (Rapid Testing); and 2) treating patients identified due to late-stage symptoms (Usual Care); to determine which program was the most financially feasible. METHODS: Using a dynamic decision-analysis model, we estimated the financial impact of each program over a 7-year period. Costs were driven by patient disease-severity at diagnosis, measured by CD4+ category, and the proportion of patients in each disease-severity category. Cost per CD4+ category was modeled from chart review and database analysis of treatment-naive HIV-positive patients. Distributions of CD4+ counts differed in patients across the Rapid Testing and Usual Care arms. RESULTS: A non-targeted Rapid Testing program was not significantly more costly than Usual Care. Although Rapid Testing had substantial screening costs, they were offset by lower inpatient expenses associated with earlier identification of disease. Assuming an HIV prevalence of 1% and 80% test acceptance, the cost of Rapid Testing was $1,418,088, vs. $1,320,338 for Usual Care (p=0.5854). Results support implementation of non-targeted rapid HIV screening in integrated systems. CONCLUSIONS: This analysis adds a new component of support for HIV screening by demonstrating that rapid, non-targeted testing does not cost significantly more than a diagnostic testing approach.

DOI of Published Version

At the time of publication, Kristin Mattocks was not yet affiliated with the University of Massachusetts Medical School.

Related Resources
Link to Article in PubMed
PubMed ID
Citation Information
Risha Gidwani, Matthew Bidwell Goetz, Gerald Kominski, Steven Asch, et al.. "A budget impact analysis of rapid human immunodeficiency virus screening in Veterans Administration emergency departments" Vol. 42 Iss. 6 (2012) ISSN: 0736-4679 (Linking)
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