Wider Screening for HIV Is Cost Effective
Routine voluntary screening for HIV is as cost-effective as other common health care interventions and should be adopted far more widely, according to a study published in the February 10, 2005 issue of the New England Journal of Medicine.
An international research team from the U.S. and Canada, coordinated through the U.S. Veterans Affairs (VA) Palo Alto Health Care System, used a sophisticated software model to find that routine testing for HIV is cost-effective even in healthcare settings where as few as 1 in 2,000 patients unknowingly carries the virus.
Health Canada estimates that of the 56,000 people with HIV living in Canada, approximately 16,800 (30 per cent) are unaware of their status. In the U.S., it is estimated that 280,000 of the estimated 1-million living with HIV are unaware of their status.
Current guidelines from the U.S. Centers for Disease Control and Prevention recommend routine HIV screening only for populations in which the estimated prevalence is 1 in 100 patients or greater.
"At this point, HIV screening in Canada occurs primarily in the context of the doctor-patient relationship. Other than in pregnancy, routine screening for HIV has not been explicitly addressed as a public health issue," said Dr. Ahmed Bayoumi of St. Michael's Hospital's Centre for Research on Inner City Health and assistant professor at the University of Toronto and one of the study's authors. Lead author on the study is fellow Canadian Gillian D. Sanders, PhD, of Duke University. Other participating researchers were from the U.S. VA Palo Alto Health Care System.
"Our study indicates that voluntary HIV screening results in important benefits both to the person identified as having HIV and to the community from reduced transmission of HIV. And because screening is good value for money, policy makers should consider expanding and implementing routine voluntary testing policies," added Dr. Bayoumi.
To determine their findings, the researchers developed a mathematical model that accounted for dozens of costs associated with HIV screening, including treatment with expensive antiretroviral drugs for patients who tested positive. Balanced against those costs were added years of healthier life for those whose infection was detected and treated and avoided cases of transmitted disease.