Department of Public Health, Weill Cornell Medical College, 402 East 67th Street, New York, NY 10065, USA.
Drug Alcohol Depend. 2013 Feb 1;128(1-2):90-7. doi: 10.1016/j.drugalcdep.2012.08.009. Epub 2012 Sep 9.
The President's National HIV/AIDS Strategy calls for coupling HIV screening and prevention services with substance abuse treatment programs. Fewer than half of US community-based substance abuse treatment programs make HIV testing available on-site or through referral.
We measured the cost-effectiveness of three HIV testing strategies evaluated in a randomized trial conducted in 12 community-based substance abuse treatment programs in 2009: off-site testing referral, on-site rapid testing with information only, on-site rapid testing with risk-reduction counseling. Data from the trial included patient demographics, prior testing history, test acceptance and receipt of results, undiagnosed HIV prevalence (0.4%) and program costs. The Cost-Effectiveness of Preventing AIDS Complications (CEPAC) computer simulation model was used to project life expectancy, lifetime costs, and quality-adjusted life years (QALYs) for HIV-infected individuals. Incremental cost-effectiveness ratios (2009 US $/QALY) were calculated after adding costs of testing HIV-uninfected individuals; costs and QALYs were discounted at 3% annually.
Referral for off-site testing is less efficient (dominated) compared to offering on-site testing with information only. The cost-effectiveness ratio for on-site testing with information is $60,300/QALY in the base case, or $76,300/QALY with 0.1% undiagnosed HIV prevalence. HIV risk-reduction counseling costs $36 per person more without additional benefit.
A strategy of on-site rapid HIV testing offer with information only in substance abuse treatment programs increases life expectancy at a cost-effectiveness ratio <$100,000/QALY. Policymakers and substance abuse treatment leaders should seek funding to implement on-site rapid HIV testing in substance abuse treatment programs for those not recently tested.
总统的国家艾滋病毒/艾滋病战略呼吁将艾滋病毒筛查和预防服务与药物滥用治疗计划相结合。在美国，不到一半的社区药物滥用治疗计划提供现场或通过转介进行艾滋病毒检测。
我们衡量了三种艾滋病毒检测策略的成本效益，这些策略在 2009 年在 12 个社区药物滥用治疗计划中进行的随机试验中进行了评估：场外测试转介、现场快速测试仅提供信息、现场快速测试与风险降低咨询。试验数据包括患者人口统计学、先前的检测史、检测接受和结果接收、未确诊的艾滋病毒流行率（0.4%）和计划成本。预防艾滋病并发症的成本效益（CEPAC）计算机模拟模型用于预测艾滋病毒感染者的预期寿命、终身成本和质量调整生命年（QALY）。在添加检测 HIV 未感染者的成本后，计算了增量成本效益比（2009 年美国美元/QALY）；成本和 QALY 按每年 3%贴现。
与提供仅提供信息的现场测试相比，转介进行场外测试效率较低（被支配）。现场测试仅提供信息的成本效益比在基本情况下为 60300 美元/QALY，或在未确诊的 HIV 流行率为 0.1%的情况下为 76300 美元/QALY。没有额外收益的情况下，艾滋病毒风险降低咨询每人增加 36 美元的成本。
在药物滥用治疗计划中，仅提供信息的现场快速艾滋病毒检测策略以低于 10 万美元/QALY 的成本效益比增加了预期寿命。政策制定者和药物滥用治疗领导者应寻求资金，为最近未接受检测的人在药物滥用治疗计划中实施现场快速艾滋病毒检测。
