Sanders Gillian D, Bayoumi Ahmed M, Holodniy Mark, Owens Douglas K
Duke Clinical Research Institute, Durham, North Carolina 27715, USA.
Ann Intern Med. 2008 Jun 17;148(12):889-903. doi: 10.7326/0003-4819-148-12-200806170-00002.
Although HIV infection is more prevalent in people younger than age 45 years, a substantial number of infections occur in older persons. Recent guidelines recommend HIV screening in patients age 13 to 64 years. The cost-effectiveness of HIV screening in patients age 55 to 75 years is uncertain.
To examine the costs and benefits of HIV screening in patients age 55 to 75 years.
Markov model.
Derived from the literature.
Patients age 55 to 75 years with unknown HIV status.
Lifetime.
Societal.
HIV screening program for patients age 55 to 75 years compared with current practice.
Life-years, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness.
RESULTS OF BASE-CASE ANALYSIS: For a 65-year-old patient, HIV screening using traditional counseling costs $55,440 per QALY compared with current practice when the prevalence of HIV was 0.5% and the patient did not have a sexual partner at risk. In sexually active patients, the incremental cost-effectiveness ratio was $30,020 per QALY. At a prevalence of 0.1%, HIV screening cost less than $60,000 per QALY for patients younger than age 75 years with a partner at risk if less costly streamlined counseling is used.
Cost-effectiveness of HIV screening depended on HIV prevalence, age of the patient, counseling costs, and whether the patient was sexually active. Sensitivity analyses with other variables did not change the results substantially.
The effects of age on the toxicity and efficacy of highly active antiretroviral therapy and death from AIDS were uncertain. Sensitivity analyses exploring these variables did not qualitatively affect the results.
If the tested population has an HIV prevalence of 0.1% or greater, HIV screening in persons from age 55 to 75 years reaches conventional levels of cost-effectiveness when counseling is streamlined and if the screened patient has a partner at risk. Screening patients with advanced age for HIV is economically attractive in many circumstances.
尽管HIV感染在45岁以下人群中更为普遍，但仍有相当数量的感染发生在老年人中。近期指南建议对13至64岁的患者进行HIV筛查。55至75岁患者中HIV筛查的成本效益尚不确定。
探讨55至75岁患者进行HIV筛查的成本和效益。
马尔可夫模型。
源自文献。
55至75岁HIV感染状况未知的患者。
终生。
社会。
与当前做法相比，针对55至75岁患者的HIV筛查项目。
生命年、质量调整生命年（QALY）、成本和增量成本效益。
对于一名65岁的患者，当HIV患病率为0.5%且患者没有性伴感染风险时，与当前做法相比，采用传统咨询方式进行HIV筛查每获得一个QALY的成本为55,440美元。在性活跃患者中，增量成本效益比为每QALY 30,020美元。如果采用成本较低的简化咨询方式，在患病率为0.1%时，对于有性伴感染风险的75岁以下患者，HIV筛查每获得一个QALY的成本低于60,000美元。
HIV筛查的成本效益取决于HIV患病率、患者年龄、咨询成本以及患者是否性活跃。对其他变量进行的敏感性分析并未使结果发生实质性改变。
年龄对高效抗逆转录病毒治疗的毒性和疗效以及艾滋病死亡的影响尚不确定。探索这些变量的敏感性分析并未在质量上影响结果。
如果受检人群的HIV患病率为0.1%或更高，当咨询方式简化且筛查患者有性伴感染风险时，对55至75岁人群进行HIV筛查可达到传统的成本效益水平。在许多情况下，对高龄患者进行HIV筛查在经济上具有吸引力。
