NIDA-Funded Studies Show Expanding HIV Screening Is Cost Effective
Two multicenter research teams supported in part by the National
Institute on Drug Abuse, National Institutes of Health, have independently
determined through the development of computer models that routine
screening for HIV in health care settings is as cost effective
as screening for such other conditions as breast cancer and high
blood pressure, and can provide important health and survival benefits.
The studies also suggest that screening that leads to a diagnosis
of HIV infection may further lower health care costs by preventing
high-risk practices and decreasing virus transmission.
Both studies — one led by Dr. Gillian Sanders at Duke Clinical
Research Institute at Duke University and Dr. Douglas Owens at
the Veterans Affairs Palo Alto Health Care System; and one led
by Dr. A. David Paltiel at Yale School of Medicine — are
published in the February 10, 2005 issue of the New England Journal
“Of the nearly 1 million people in the United States infected
with HIV, about 280,000 are unaware of their status,” says
NIDA Director Dr. Nora D. Volkow. “Current patterns of screening
are inconsistent, and people generally are diagnosed late in their
disease. There is the possibility that by expanding screening,
people identified with HIV can begin highly effective and lifesaving
medical therapy early on and improve their quality of life. And,
by realizing their HIV status sooner, people may reduce high-risk
behaviors and decrease transmission of this virus.”
In the first study, the scientists developed a computer model
to follow a hypothetical group of 43-year-old men and women whose
HIV status was unknown, to estimate the health costs and benefits
associated with voluntary HIV screening in health care settings.
“As part of the study, we analyzed the costs associated
with HIV testing, counseling, followup, and treatment,” says
Dr. Sanders. “While no computer model is a perfect representation
of reality, the results suggest that a one-time HIV screening program
provides a very important health benefit and is a good value, even
in populations with a relatively low proportion of people with
HIV. In the end, a one-time screening costs about $15,078 for every
year of life gained, a figure that takes into account the resulting
reduction in virus transmission and benefits to partners.”
“An intervention that costs under $20,000 per quality-adjusted
life year gained would definitely be recognized as providing good
value,” notes Dr. Sanders. A quality-adjusted life year is
a standard health outcome measure used by many researchers. It
is a way to account for both longevity and health-related quality
In addition, the researchers found that implementing a one-time
screening program could reduce the annual HIV transmission rate
over these patients’ lifetimes by 21 percent compared to
In the second study, researchers developed a computer model that
compared costs associated with HIV screening and current voluntary
HIV diagnostic and counseling practices in three populations: a “high-risk” population
in which 3 percent had undiagnosed HIV infection, a population
in which 1 percent had undiagnosed HIV, and the general population
in which the prevalence of undiagnosed HIV was 0.1 percent. They
found that routine, voluntary HIV screening every 3 to 5 years
provides clinical benefits and is cost effective in all but the
lowest-risk populations. One-time screening in the general U.S.
population also may be cost effective.
“Our study suggests that routine HIV counseling, testing,
and referral should be extended,” says Dr. Paltiel. “In
populations barely meeting a 1 percent prevalence of undiagnosed
HIV infection, the costs per quality-adjusted life year gained
of HIV testing every 3 to 5 years compare favorably with those
of many commonly used screening interventions in chronic conditions,
including breast cancer, colorectal cancer, diabetes, and high
Data from other cost-effectiveness studies show that screening
for type 2 diabetes costs approximately $56,600 per quality-adjusted
life year gained, while screening costs for high blood pressure
and colorectal cancer cost $48,000 and $51,200, respectively.
Further research might reveal the best ways to implement HIV screening
programs, how to reduce existing barriers to screening, how to
increase the effects of counseling on patient knowledge, and the
cost-effectiveness of HIV screening in the elderly.
“These studies suggest that voluntary screening for HIV
is justified in certain populations and may offer significant benefits
on both clinical and cost-effectiveness grounds,” says Dr.
Volkow. “Additional research is needed to determine if one-time
screening for undiagnosed HIV in the general population also is
The National Institute on Drug Abuse is a component of the National
Institutes of Health, U.S. Department of Health and Human Services.
NIDA supports more than 85 percent of the world’s research
on the health aspects of drug abuse and addiction. The Institute
carries out a large variety of programs to ensure the rapid dissemination
of research information and its implementation in policy and practice.
Fact sheets on the health effects of drugs of abuse and information
on NIDA research and other activities can be found on the NIDA
home page at http://www.drugabuse.gov.