La Croix S J, Russo G
Department of Economics, University of Hawaii, Honolulu 96822, USA.
Soc Sci Med. 1996 May;42(9):1259-72. doi: 10.1016/0277-9536(95)00221-9.
The objectives of this paper are threefold: first, to develop a taxonomy of potential benefits from voluntary, routine HIV-antibody testing of hospital patients; second, to inform attending healthcare workers, hospital patients and policy makers of the potential benefits from such testing; and third, to make inferences about whether such testing is warranted by a cost-benefit criterion. Benefits stemming from information about a patient's HIV serostatus accrue to: (1) healthcare workers if extra precautions reduce their HIV-exposure rate; (2) the patient if knowledge of HIV serostatus allows life-extending prophylactic treatment to be initiated; and (3) the patient's sex partners if the patient is less likely to transmit HIV after undergoing HIV testing. Using recent estimates on the value of life, hospital-specific HIV-prevalence rates, the effectiveness of prophylactic treatment, rates of HIV exposure and conversion by healthcare workers, and reduction in high-risk sexual behaviors by seropositive patients, we estimate the benefits of testing as the value of statistical life saved. The opportunity cost of HIV testing is calculated as the reported cost of a standard HIV-test protocol with pre- and post-test counseling. Information about a patient's HIV serostatus provides small expected benefits to healthcare workers ($3.34) because the risk of HIV transmission is small; benefits to attending healthcare workers are insufficient to warrant routine HIV testing on a stand-alone basis even in high HIV-prevalence hospitals. However, an HIV-seropositive test result provides large expected benefits to the patient ($11,202) and to the patient's sex partners ($5271). Adding these nonrivalrous benefits, we find that routine, voluntary HIV-testing of hospital patients passes a cost-benefit test even in low HIV-prevalence hospitals. Four major qualifications of the cost-benefit analysis should be considered. (1) The benefits to some parties can only be achieved if the patient's serostatus is disclosed to them. (2) The net benefits may be negative if HIV-testing induces riskier behavior. (3) The analysis does not incorporate the significant potential for third-parties (employers, insurers, healthcare workers) to use the test to impose costs on HIV-seropositive patients. (4) The sample of inpatients choosing voluntary HIV testing may not be representative of the overall hospital population. These unmeasured factors suggest that policymakers should exercise caution in implementing a voluntary HIV-testing program.
第一，建立医院患者自愿进行常规艾滋病毒抗体检测潜在益处的分类；第二，让医护人员、医院患者和政策制定者了解此类检测的潜在益处；第三，依据成本效益标准推断此类检测是否合理。患者艾滋病毒血清状态信息带来的益处包括：（1）如果额外的预防措施降低了医护人员的艾滋病毒暴露率，那么对医护人员有益；（2）如果了解艾滋病毒血清状态能使患者开始延长生命的预防性治疗，那么对患者有益；（3）如果患者在接受艾滋病毒检测后传播艾滋病毒的可能性降低，那么对患者的性伴侣有益。利用近期关于生命价值、医院特定的艾滋病毒流行率、预防性治疗的有效性、医护人员的艾滋病毒暴露和感染率，以及血清阳性患者高危性行为减少情况的估计，我们将检测的益处估计为挽救的统计生命的价值。艾滋病毒检测的机会成本计算为报告的标准艾滋病毒检测方案（包括检测前和检测后咨询）的成本。患者艾滋病毒血清状态信息给医护人员带来的预期益处较小（3.34美元），因为艾滋病毒传播风险较小；即使在艾滋病毒高流行率的医院，对医护人员的益处也不足以保证单独进行常规艾滋病毒检测。然而，艾滋病毒血清阳性检测结果给患者（11202美元）和患者的性伴侣（5271美元）带来了较大的预期益处。加上这些非竞争性益处，我们发现即使在艾滋病毒低流行率的医院，对医院患者进行常规自愿艾滋病毒检测也通过了成本效益测试。成本效益分析应考虑四个主要限定条件。（1）只有向某些方披露患者的血清状态，才能实现对他们的益处。（2）如果艾滋病毒检测引发更危险的行为，净益处可能为负。（3）该分析未纳入第三方（雇主、保险公司、医护人员）利用检测对艾滋病毒血清阳性患者施加成本的重大可能性。（4）选择自愿进行艾滋病毒检测的住院患者样本可能不代表整个医院人群。这些未衡量的因素表明，政策制定者在实施自愿艾滋病毒检测计划时应谨慎行事。
