Budget Impact Analysis of HIV Testing in the VA Healthcare System
| Autor: | Kee Chan, Henry D. Anaya, Steven M. Asch, Uday S. Karmarkar, Matthew Bidwell Goetz |
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| Rok vydání: | 2012 |
| Předmět: |
Budgets
medicine.medical_specialty Cost effectiveness Cost-Benefit Analysis Health Personnel Psychological intervention HIV Infections Intervention effect Hiv testing Sensitivity and Specificity facility costs medicine Humans Mass Screening budget impact analysis Operations management cost-effectiveness Veterans Affairs health care economics and organizations business.industry Health Policy Public Health Environmental and Occupational Health AIDS Serodiagnosis Budget impact Health Services Viral Load United States HIV testing CD4 Lymphocyte Count United States Department of Veterans Affairs Anti-Retroviral Agents Cohort Emergency medicine business Healthcare system |
| Zdroj: | Value in Health. 15:1022-1028 |
| ISSN: | 1098-3015 |
| DOI: | 10.1016/j.jval.2012.08.2205 |
| Popis: | Objectives: The long-term cost effectiveness of routine HIV testing is favorable relative to other medical interventions. Facility-specific costs of expanded HIV testing and care for newly identified patients, however, are less well defined. To aid in resource allocation decisions, we developed a spreadsheet-based budget-impact tool populated with estimates of facility-specific HIV testing and care costs incurred with an expanded testing program. Methods: We modeled intervention effects on quarterly costs of antiretroviral therapy (ART), outpatient resource utilization, and staff expenditures in the Department of Veterans Affairs over a 2-year period of increasing HIV testing rates. We used HIV prevalence estimates, screening rates, counseling, positive tests, Veterans Affairs treatment, and published sources as inputs. We evaluated a single-facility cohort of 20,000 patients and at baseline assumed a serodiagnostic rate of 0.45%. Results: Expanding testing from 2% to 15% annually identified 21 additional HIV-positive patients over 2 years at a cost of approximately $290,000, more than 60% of which was due to providing ART to newly diagnosed patients. While quarterly testing costs decreased longitudinally as fewer persons required testing, quarterly ART costs increased from $10,000 to more than $60,000 over 2 years as more infected patients were identified and started on ART. In sensitivity analyses, serodiagnostic and annual HIV testing rates had the greatest cost impact. Conclusions: Expanded HIV testing costs are greatest during initial implementation and predominantly due to ART for new patients. Cost determinations of expanded HIV testing provide an important tool for managers charged with allocating resources within integrated systems providing both HIV testing and care. |
| Databáze: | OpenAIRE |
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