Department of Medicine, University of California, San Francisco, USA.
Acad Emerg Med. 2011 Jul;18(7):745-53. doi: 10.1111/j.1553-2712.2011.01110.x.
Although targeted screening of patients at high risk for human immunodeficiency virus (HIV) infection in the emergency department (ED) improves patient outcomes and may prevent HIV transmission, ED-based screening programs incur additional costs and have thus not been widely scaled up. The objective of this study was to evaluate the cost-effectiveness of ED-based targeted HIV screening as implemented in actual practice.
This was a cost-utility analysis of a rapid HIV screening program in an urban ED. Physicians were encouraged to screen patients undergoing inpatient admission or who had HIV risk factors. The authors measured costs directly and estimated quality-adjusted life expectancy using chart review, literature assumptions, and mathematical modeling. Incremental cost utility was evaluated from a societal perspective using a lifetime time horizon.
From June 2008 through September 2009, a total of 3,766 HIV tests were ordered (235 tests per month), of which an estimated 2,406 (64%) represented screening in patients without HIV-related signs or symptoms. Nineteen (0.8%) patients were newly diagnosed through screening during the study period, of whom nine (47%) were eligible for antiretroviral therapy (ART) and maintained consistent outpatient follow-up. Estimated screening costs were $82,300 per year, or $45.53 per screening test, of which $28.01 (62%) was for program management. Targeted screening prevented an estimated 2.1 HIV transmission events over 16 months. Per patient screened, targeted screening saved $112 (95% uncertainty range [UR] = $20 to $225) and resulted in 2.71 quality-adjusted life-days gained (95% UR = 1.71 to 4.01). Cost-utility was most sensitive to the prevalence of undiagnosed HIV in the screened population.
Targeted HIV screening, as implemented in an urban ED, is cost saving and increases quality-adjusted life expectancy.
尽管在急诊部门（ED）对感染人类免疫缺陷病毒（HIV）风险较高的患者进行有针对性的筛查可改善患者预后，并可能预防 HIV 传播，但 ED 基于的筛查计划会增加额外成本，因此尚未广泛推广。本研究的目的是评估在实际实践中实施的 ED 基于有针对性的 HIV 筛查的成本效益。
这是一项对城市 ED 中快速 HIV 筛查计划的成本效益分析。医生被鼓励对住院患者或有 HIV 风险因素的患者进行筛查。作者通过图表审查、文献假设和数学建模直接衡量成本，并估计质量调整后的预期寿命。使用终生时间范围从社会角度评估增量成本效益。
从 2008 年 6 月至 2009 年 9 月，共进行了 3766 次 HIV 检测（每月 235 次），其中估计有 2406 次（64%）代表无 HIV 相关症状或体征的患者进行了筛查。在研究期间，通过筛查新诊断出 19 例（0.8%）患者，其中 9 例（47%）符合接受抗逆转录病毒治疗（ART）的条件，并保持持续的门诊随访。估计筛查成本为每年 82300 美元，或每次筛查测试 45.53 美元，其中 28.01 美元（62%）用于项目管理。有针对性的筛查在 16 个月内预防了约 2.1 例 HIV 传播事件。每筛查一名患者，有针对性的筛查可节省 112 美元（95%置信区间[UR]为 20 至 225 美元），并导致 2.71 个质量调整生命天数的增加（95% UR 为 1.71 至 4.01）。成本效益对筛查人群中未确诊 HIV 的流行率最为敏感。
在城市 ED 中实施的有针对性的 HIV 筛查具有成本效益，可以提高质量调整后的预期寿命。
