Display Settings:

Format

Send to:

Choose Destination
We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Ann Intern Med. 2008 Jun 17;148(12):889-903.

Cost-effectiveness of HIV screening in patients older than 55 years of age.

Author information

  • 1Duke Clinical Research Institute, Durham, North Carolina 27715, USA.

Abstract

BACKGROUND:

Although HIV infection is more prevalent in people younger than age 45 years, a substantial number of infections occur in older persons. Recent guidelines recommend HIV screening in patients age 13 to 64 years. The cost-effectiveness of HIV screening in patients age 55 to 75 years is uncertain.

OBJECTIVE:

To examine the costs and benefits of HIV screening in patients age 55 to 75 years.

DESIGN:

Markov model.

DATA SOURCES:

Derived from the literature.

TARGET POPULATION:

Patients age 55 to 75 years with unknown HIV status.

TIME HORIZON:

Lifetime.

PERSPECTIVE:

Societal.

INTERVENTION:

HIV screening program for patients age 55 to 75 years compared with current practice.

OUTCOME MEASURES:

Life-years, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness.

RESULTS OF BASE-CASE ANALYSIS:

For a 65-year-old patient, HIV screening using traditional counseling costs $55,440 per QALY compared with current practice when the prevalence of HIV was 0.5% and the patient did not have a sexual partner at risk. In sexually active patients, the incremental cost-effectiveness ratio was $30,020 per QALY. At a prevalence of 0.1%, HIV screening cost less than $60,000 per QALY for patients younger than age 75 years with a partner at risk if less costly streamlined counseling is used.

RESULTS OF SENSITIVITY ANALYSIS:

Cost-effectiveness of HIV screening depended on HIV prevalence, age of the patient, counseling costs, and whether the patient was sexually active. Sensitivity analyses with other variables did not change the results substantially.

LIMITATIONS:

The effects of age on the toxicity and efficacy of highly active antiretroviral therapy and death from AIDS were uncertain. Sensitivity analyses exploring these variables did not qualitatively affect the results.

CONCLUSION:

If the tested population has an HIV prevalence of 0.1% or greater, HIV screening in persons from age 55 to 75 years reaches conventional levels of cost-effectiveness when counseling is streamlined and if the screened patient has a partner at risk. Screening patients with advanced age for HIV is economically attractive in many circumstances.

PMID:
18559840
[PubMed - indexed for MEDLINE]
PMCID:
PMC3428219
Free PMC Article

Images from this publication.See all images (4)Free text

Figure 1
Figure 2
Figure 3
Figure 4
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Silverchair Information Systems Icon for PubMed Central
    Loading ...
    Write to the Help Desk