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Press Release
Study urges wider screening for HIV
January 27, 2005
Routine voluntary screening for HIV is as cost-effective as other common preventive tests, such as mammograms and colonoscopies, and should be adopted far more widely by U.S. hospitals and clinics, according to a study published in the Feb. 10 New England Journal of Medicine.
Using a sophisticated software model, a team led by researchers from the Department of Veterans Affairs, Duke University and Stanford University found that routine testing for HIV appears cost-effective even in healthcare settings where as few as 1 in 2,000 patients carries the virus unknowingly. Current guidelines from the Centers for Disease Control and Prevention recommend routine HIV screening only for higher-risk populations, in which the estimated prevalence is closer to 1 in 100 patients.
"We know 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 cost-effective, as indicated in our study, routine voluntary testing should be offered more broadly than has been the case," said senior author Douglas K. Owens, MD, of the VA Palo Alto Health Care System and Stanford University. Lead author on the study was Gillian D. Sanders, PhD, of Duke University.
The researchers developed a mathematical model that took into account 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, plus avoided cases of transmitted disease.
Among the findings:
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Even in low-risk settings, where as few as 1 in 2,000 people would theoretically have undiagnosed HIV, the cost of screening would still be less than $50,000 per added year of higher-quality life. Healthcare economists typically use $50,000 as a rough threshold for deeming a screening procedure "cost effective."
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In high-risk settings, where 1 in 100 patients could be expected to have unidentified HIV, routine screening would cost $15,078 per quality-adjusted life-year.
For healthcare systems and society on the whole, screenings are often a net expense, not a savings, in part because of the huge numbers of patients who are tested but have no illness, and in part because treatment may be expensive, as in the case of HIV. Still, certain procedures are seen as "cost effective" if they benefit enough people without exceedingly large costs.
Findings from Owens’ study are consistent with those from a similar study by a group at Yale School of Medicine and Harvard University, published in the same issue of the New England Journal. Taken together, said Owens, the studies suggest that HIV screening programs should be expanded in many healthcare settings across the United States, including even primary-care clinics where the prevalence of undiagnosed HIV might reach 1 in 2000, or 0.05 percent.
An earlier study by Owens at six VA outpatient clinics found a prevalence of undiagnosed HIV ranging from 0.13 to 2.9 percent. VA offers voluntary HIV testing, with written consent, for all patients, and has the nation’s most extensive HIV treatment program. VA also maintains the world’s largest clinical database on HIV, with 55,000 patients.
According to the Centers for Disease Control and Prevention, as many as 950,000 Americans are living with HIV infection, and a quarter of them are unaware of it. About 40,000 new HIV infections occur each year. Early detection and treatment with antiretroviral drugs has been shown to extend lives and prevent transmission of the virus.
The study was funded by VA, the Ontario HIV Treatment Network, and the National Institute on Drug Abuse. Collaborating with Owens and Sanders were researchers at Duke University; Stanford University; St. Michael’s Hospital and the University of Toronto in Canada; and the Veterans Affairs Palo Alto Health Care System.
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