Public Health Department, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
Division of Infectious Diseases, University of Nebraska Medical Center College of Medicine, Omaha, NE, USA.
AIDS Care. 2021 Oct;33(10):1243-1254. doi: 10.1080/09540121.2020.1817299. Epub 2020 Sep 15.
In 2016 worldwide, 1.8 million people were newly infected with HIV. About 36.7 million had HIV but 14 million were unaware, did not seek treatment and were likely to infect others. Undiagnosed HIV infection is a major contributor to transmission. Therefore, screening is critical to prevention. Although CDC recommends routine screening in the emergency department (ED), implementation is not universal or sustained. Cost-effectiveness of ED-based screening could enhance implementation. We address the question: ? Using the Joanna Briggs Institute guidelines, we conducted a systematic review of economic evaluations of ED-based HIV screening. We found 311 studies with 12 duplicates. We excluded 276 studies that did not conduct economic evaluations and another three for lack of quantitative data, leaving 20 articles for the full review. We reviewed cost-effectiveness ratios (CER), incremental cost-effectiveness ratios (ICER), and average costs per diagnosis, quality-adjusted life years, averted transmissions and per patient linked to care. CER and ICER were below CDC thresholds indicating that HIV screening in the ED is cost-effective. Therefore, ED-based HIV screening should be widely implemented, supported and sustained as a cost-effective tool for combating HIV/AIDS.
2016 年，全球有 180 万人新感染艾滋病毒。约有 3670 万人感染艾滋病毒，但有 1400 万人未被发现，他们没有寻求治疗，可能会感染他人。未确诊的艾滋病毒感染是传播的主要原因。因此，筛查对于预防至关重要。尽管疾病预防控制中心建议在急诊室进行常规筛查，但并非普遍实施或持续实施。基于急诊室的筛查的成本效益可能会增强实施。我们提出了这样一个问题：利用乔安娜·布里格斯研究所的指导原则，我们对基于急诊室的艾滋病毒筛查的经济评估进行了系统回顾。我们发现了 311 项研究，其中有 12 项是重复的。我们排除了 276 项没有进行经济评估的研究，另外 3 项由于缺乏定量数据而被排除在外，留下 20 篇文章进行全面审查。我们审查了成本效益比（CER）、增量成本效益比（ICER）、每例诊断的平均成本、质量调整生命年、预防传播和每例患者与护理相关的成本。CER 和 ICER 均低于疾病预防控制中心的阈值，表明急诊室的艾滋病毒筛查具有成本效益。因此，应广泛实施、支持和维持基于急诊室的艾滋病毒筛查，将其作为防治艾滋病毒/艾滋病的一种具有成本效益的工具。
