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Resource Utilization and Cost-Effectiveness of Counselor- vs. Provider-Based Rapid Point-of-Care HIV Screening in the Emergency Department

Author

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  • Rochelle P Walensky
  • Bethany L Morris
  • William M Reichmann
  • A David Paltiel
  • Christian Arbelaez
  • Laurel Donnell-Fink
  • Jeffrey N Katz
  • Elena Losina

Abstract

Background: Routine HIV screening in emergency department (ED) settings may require dedicated personnel. We evaluated the outcomes, costs and cost-effectiveness of HIV screening when offered by either a member of the ED staff or by an HIV counselor. Methods: We employed a mathematical model to extend data obtained from a randomized clinical trial of provider- vs. counselor-based HIV screening in the ED. We compared the downstream survival, costs, and cost-effectiveness of three HIV screening modalities: 1) no screening program; 2) an ED provider-based program; and 3) an HIV counselor-based program. Trial arm-specific data were used for test offer and acceptance rates (provider offer 36%, acceptance 75%; counselor offer 80%, acceptance 71%). Undiagnosed HIV prevalence (0.4%) and linkage to care rates (80%) were assumed to be equal between the screening modalities. Personnel costs were derived from trial-based resource utilization data. We examined the generalizability of results by conducting sensitivity analyses on offer and acceptance rates, undetected HIV prevalence, and costs. Results: Estimated HIV screening costs in the provider and counselor arms averaged $8.10 and $31.00 per result received. The Provider strategy (compared to no screening) had an incremental cost-effectiveness ratio of $58,700/quality-adjusted life year (QALY) and the Counselor strategy (compared to the Provider strategy) had an incremental cost-effectiveness ratio of $64,500/QALY. Results were sensitive to the relative offer and acceptance rates by strategy and the capacity of providers to target-screen, but were robust to changes in undiagnosed HIV prevalence and programmatic costs. Conclusions: The cost-effectiveness of provider-based HIV screening in an emergency department setting compares favorably to other US screening programs. Despite its additional cost, counselor-based screening delivers just as much return on investment as provider based-screening. Investment in dedicated HIV screening personnel is justified in situations where ED staff resources may be insufficient to provide comprehensive, sustainable screening services.

Suggested Citation

  • Rochelle P Walensky & Bethany L Morris & William M Reichmann & A David Paltiel & Christian Arbelaez & Laurel Donnell-Fink & Jeffrey N Katz & Elena Losina, 2011. "Resource Utilization and Cost-Effectiveness of Counselor- vs. Provider-Based Rapid Point-of-Care HIV Screening in the Emergency Department," PLOS ONE, Public Library of Science, vol. 6(10), pages 1-10, October.
  • Handle: RePEc:plo:pone00:0025575
    DOI: 10.1371/journal.pone.0025575
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    Cited by:

    1. Jason S Haukoos & Jonathan D Campbell & Amy A Conroy & Emily Hopkins & Meggan M Bucossi & Comilla Sasson & Alia A Al-Tayyib & Mark W Thrun & For the Denver ED HIV Opt-Out Study Group, 2013. "Programmatic Cost Evaluation of Nontargeted Opt-Out Rapid HIV Screening in the Emergency Department," PLOS ONE, Public Library of Science, vol. 8(12), pages 1-6, December.
    2. Bert, Fabrizio & Gualano, Maria Rosaria & Biancone, Paolo & Brescia, Valerio & Camussi, Elisa & Martorana, Maria & Secinaro, Silvana & Siliquini, Roberta, 2018. "Cost-effectiveness of HIV screening in high-income countries: A systematic review," Health Policy, Elsevier, vol. 122(5), pages 533-547.

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