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Routine HIV Screening of Adults Is Cost-Effective

Screening not cost-effective if prevalence of undiagnosed HIV is below 0.2 percent

TUESDAY, Dec. 5 (HealthDay News) -- A cost-effectiveness analysis for routine HIV screening has determined that all U.S. adults should be screened unless the prevalence of undiagnosed HIV is below 0.2 percent, researchers report in the Dec. 5 issue of the Annals of Internal Medicine.

A. David Paltiel, Ph.D., from Yale School of Medicine in New Haven, Conn., and colleagues used a mathematical model to simulate the cost-effectiveness ratios (in discounted 2004 dollars per quality-adjusted life-year, or QALY) of adult HIV screening based on HIV transmission risk, with and without antiretroviral treatment.

Assuming an HIV prevalence of 1 percent, an annual incidence of 0.12 percent and moderately favorable assumptions on transmission, the researchers found that the cost-effectiveness ratios varied from $30,800 to $55,500 QALY gained for one-time screening or screening every three years, respectively. With a prevalence of 0.10 percent and an annual incidence of 0.014 percent, the cost-effectiveness ratio increased to $60,700 QALY gained for one-time screening.

"Routine, rapid HIV testing is recommended for all adults except in settings where there is evidence that the prevalence of undiagnosed HIV infection is below 0.2 percent," the authors conclude.

"Eventually, reminiscent of successful screening programs for syphilis and tuberculosis, the cost-effectiveness question for HIV will change from whether we should screen for HIV to when we should stop," states an accompanying editorial.

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