Human immunodeficiency virus counseling, testing, referral, and partner notification services. A cost-benefit analysis
D. R. Holtgrave, R. O. Valdiserri, A. R. Gerber and A. R. Hinman
National Center for Prevention Services, Centers for Disease Control and Prevention, Atlanta, GA.
BACKGROUND: The Centers for Disease Control and Prevention (Atlanta, Ga)
annually provides more than +100 million in funding to states, territories,
and cities for the provision of human immunodeficiency virus (HIV)
counseling, testing, referral, and partner notification (CTRPN) services.
Given the size of this expenditure, it is important to consider the net
benefits of this program activity. We compared the economic costs and
benefits of publicly funded HIV CTRPN services. METHODS: Standard methods
for cost-benefit analysis were used. A societal perspective was employed.
Major assumptions used in the base-case analysis included the following:
(1) without public funding, the HIV CTRPN services would not be provided;
(2) for every 100 HIV-seropositive persons identified and reached by CTRPN
services, at least 20 new HIV infections are averted; and (3) for every
+100 spent on direct and indirect costs of CTRPN services, approximately
another +60 is spent on the ancillary costs of alerting people to HIV
issues and CTRPN service availability. Sensitivity analyses were performed
to explore the robustness of base-case results to these and other changes
in model assumptions. RESULTS: Under base-case assumptions, the combined
direct, indirect, and ancillary costs of the CTRPN program in 1990 dollars
were +188,217,600. At a 6% discount rate, the estimated economic benefits
of this expenditure are +3,781,918,000. The resultant benefit-cost ratio is
20.09. Sensitivity analyses showed that the benefit-cost ratio is greater
than 1 for all considered cases. CONCLUSIONS: This cost-benefit analysis
strongly suggests that publicly funded CTRPN services result in a net
economic gain to society.
