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Douglas K. Owens, MD, MSc; Robert F. Nease, Jr, PhD; Ryan A. Harris, MS

Arch Intern Med. 1996;156(4):394-404.

Abstract
Background
Although screening inpatients for human immunodeficiency virus (HIV) in acute care hospital settings has been recommended, the cost-effectiveness of screening is not known.

Objective
To estimate the cost-effectiveness of a voluntary screening program in acute care hospitals and associated clinics.

Results
During the first year, an HIV screening program implemented in acute care hospital settings in which the seroprevalence of HIV infection is 1% or more would result in the identification of approximately 110 000 undetected cases of HIV infection. The program would result in expenditures of approximately $171 million for testing and counseling, and expenditures of approximately $2 billion for incremental medical care for the patients identified as having HIV infection during the first year of screening. When the seroprevalence of HIV is 1%, the cost-effectiveness of screening is $47 200 per year of life saved. When the effect of early identification of HIV infection on the patient's quality of life also is considered, screening is less cost-effective. Screening-induced reductions in risk behavior improve the cost-effectiveness of screening by preventing the transmission of HIV.

Conclusion
The cost-effectiveness of screening for HIV in acute care settings in which the seroprevalence rate is 1% is within the range of other accepted interventions, exclusive of the effect of screening on quality of life. However, the cost-effectiveness of screening is affected substantially by the effect of screening on quality of life and by the degree to which persons identified as having HIV infection reduce risk behaviors that may transmit infection.

(Arch Intern Med. 1996;156:394-404)

Author Affiliations
From the Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif, and Division of General Internal Medicine and Department of Health Research and Policy, Stanford University, Stanford, Calif (Dr Owens and Mr Harris); and the Laboratory for Medical Decision Sciences, Division of General Medical Sciences, Washington University Medical School, St Louis, Mo (Dr Nease).

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