By Christina Orlovsky, senior staff writer
Results of two separate studies on the cost-effectiveness of routine, voluntary testing for the AIDS virus have found that the benefits of expanding HIV screening far outweigh the cost.
The studies, both published in the Feb. 10 issue of New England Journal of Medicine, concluded that widespread testing for HIV in all but lowest risk populations would not only lengthen the lives of people who test positive for the virus, but also reduce transmission of the deadly disease, without an exponential cost differential.
One study, funded by the Veterans Affairs (VA) Palo Alto Health Care System, in Palo Alto, California, looked at the cost and benefits of routine HIV screening in health care settings. According to Douglas K. Owens, M.D., senior investigator at the VA Palo Alto Health Care System and associate professor of medicine at Stanford University, the VA is the largest provider of HIV care in the United States.
"What we found is that HIV screening is cost-effective even when the prevalence of undiagnosed HIV is about .05 percent," Owens said. "That's about 20 times lower than the cutoff of the Centers for Disease Control and Prevention (CDC)."
Owens explained that CDC recommendations call for routine voluntary screening in populations where there is a 1 percent prevalence of the virus. This includes cities and densely populated suburbs. Owens contended that other populations would greatly benefit from routine screening as well.
"Early detection of the AIDS virus is important for two reasons," he said. "First, there's a benefit to the person who tests positive because they can get into care. Treatment for HIV is very good-getting it early is even better.
"Second, there's also a benefit to the community through counseling people to reduce risk behavior, which would therefore reduce risk of disease transmission," he added.
The VA study estimated that routine one-time testing for everyone could cut new infections each year by just over 20 percent, and add one-and-a-half years of life to every HIV-infected patient.
Concurring results were published in a study by researchers at Yale and Harvard universities, which found that frequent HIV screening in moderate- to high-risk settings could produce life expectancy increases at costs that compare to screening methods for other chronic conditions, such as breast cancer and diabetes.
"The publication of these papers represents a golden opportunity to jump-start the expansion of HIV testing services in the U.S.," said lead author A. David Paltiel, associate professor of health and policy administration at the Yale University School of Medicine. "Our findings, coupled with those of our colleagues, firmly establish the great value of expanded screening."
Paltiel's study pointed out that HIV infection is no longer confined to historically "at-risk" populations, and therefore, screening should not be limited. The benefits, he asserted, could be life-changing for the 280,000 HIV-positive Americans who are unaware of their status.
"HIV is a severe disease that, left untreated, produces substantial morbidity and mortality," Paltiel said. "It has a long asymptomatic phase, which can be diagnosed using very effective, inexpensive tests. Most importantly, early detection speeds linkage to proven, life-prolonging care and effective counseling to prevent further transmission."
Both study authors hope that their findings will encourage the CDC and health care providers to offer routine, voluntary HIV screening to a greater range of populations.
"Part of the CDC's initiative is to make HIV testing a routine part of medical care," Owens said. "We hope these studies will provide helpful data for them as they reevaluate their screening guidelines."
© 2005. AMN Healthcare, Inc. All Rights Reserved.