The Cost-Effectiveness of HIV Testing

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Abstract
Objective. To understand the impact of differences in participation rates between in fected and uninfected individuals on estimates of the cost-effectiveness of HIV screening. Methods. Costs per infection detected are modeled as function of both prevalence and serostatus-dependent testing rates. Data from national surveillance surveys, seroprevalence studies, and other sources are employed to suggest the mag nitude of results. Results. Differential participation produces a near-doubling in the estimated cost per infection identified. This result is sensitive to assumptions regarding the benefits of screening for seronegatives. Conclusions. Voluntary HIV screening pro grams may incur prohibitive costs by over-recruiting people at little risk of infection. Failure to account for differential participation can result in over-optimistic cost-ef fectiveness estimates. However, the relevance of this result—and the significance of both prevalence and participation as cost drivers—is overwhelmed by what is as sumed about the benefits conferred to uninfected people by HIV screening. Key words: cost-effectiveness analysis; HIV testing; policy modeling. (Med Decis Making 1997;17:490-495)