Study Suggests Routine, Oral, Rapid HIV Testing in VA Emergency Departments Financially Equivalent to Usual Care

BACKGROUND:
It is estimated that there are 1.2 million people in the US living with HIV/AIDS, and 21% are unaware of their disease status. Screening programs that diagnose patients early and offer treatment can substantially improve health outcomes, but HIV screening may not be financially viable for healthcare organizations. Using a dynamic decision analysis model, this study examined the budget impact of implementing a routine oral HIV rapid-testing program in a VA emergency department (ED) versus the impact of following ‘usual’ care. Usual care involves testing patients when they present with symptoms suggestive of HIV/AIDS, whereas routine rapid testing involves offering a test to any patient in the ED, regardless of risk factors or symptoms. Investigators used VA cost and economic data to model the costs of implementing the rapid testing program as well as the costs of treating patients identified by each of the two screening programs. Treatment costs were derived through collecting utilization data from chart review for 112 patients diagnosed and treated from FY00 to FY07, assigning FY07 costs to these data.

FINDINGS:

• A routine oral HIV screening program using a rapid testing approach is financially equivalent to following a usual care approach within the VA healthcare system. Assuming a 1% prevalence of the disease and an 80% acceptance of testing, the total cost of HIV rapid-testing was $1,418,088 versus $1,320,338 for ‘usual care.’
• While the HIV rapid-testing program had substantial screening costs, they were offset by lower inpatient expenses associated with earlier identification of disease. The higher treatment costs for ‘usual care’ patients were largely due to inpatient stays, reflecting more hospitalizations for these patients due to opportunistic infections.
• Given that early detection of HIV and linkage to treatment is associated with better health outcomes – and non-targeted testing does not result in a greater budget impact than usual care – the authors suggest that this analysis provides support for the implementation of a routine oral rapid testing program within VA.

LIMITATIONS:

• This analysis used a small sample size to determine utilization and estimate costs.
• Treatment patterns for HIV may have changed over time, raising the issue of the appropriateness of using data from FY00-FY07 to model future utilization.

AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D. Drs. Gidwani and Goetz are part of VA/HSR&D’s HIV/Hepatitis Quality Enhancement Research Initiative (HIV/Hepatitis-QUERI).

Gidwani R, Goetz M, Kominski G, et al. A Budget Impact Analysis of Rapid HIV Screening in VA Emergency Departments. Journal of Emergency Medicine January 27, 2011;e-pub ahead of print.