HIV Screening of Elderly Can Be Cost-effective
By Melinda Young
This article originally appeared in the July 2008 issue of AIDS Alert. Editor Melinda Young, Managing Editor Gary Evans, and Associate Publisher Coles Mckagen report no relationships with companies related to this field of study. Physician Reviewer Morris Harper, MD, reports consulting work with Agouron Pharmaceuticals, Gilead Sciences, Abbott Pharmaceuticals, GlaxoSmithKline, and Bristol-Myers Squibb. Nurse Planner Kay Ball is a consultant and stockholder with Steris Corp. and is on the speaker's bureau for the Association of periOperative Registered Nurses
Source: Sanders GD, Bayoumi AM, Holodniy M, et al. Cost-effectiveness of HIV screening in patients older than 55 years of age. Ann Intern Med. 2008; 148:889-903.
Although many HIV infections occur in older adults, national guidelines recommend screening only for persons age 13 to 64 years. However, researchers have found that expanding screening in people age 55 to 75 can be reasonably cost effective under the following circumstances:
- HIV prevalence is 0.1% or greater;
- a streamlined counseling process is implemented;
- and the person has a partner at risk for HIV infection.
To examine the costs and benefits of HIV screening in elderly patients the researchers used a Markov modeling technique targeting patients age 55 to 75 years with unknown HIV status. Outcome measures included life-years, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness. For a 65-year-old patient, HIV screening using traditional counseling costs $55,440 per QALY compared with current practice when the prevalence of HIV was 0.5% and the patient did not have a sexual partner at risk. In sexually active patients, the incremental cost-effectiveness ratio was $30,020 per QALY. At a prevalence of 0.1%, HIV screening cost less than $60,000 per QALY for patients younger than age 75 years with a partner at risk if less costly streamlined counseling is used, the authors reported. Cost-effectiveness of HIV screening depended on HIV prevalence, age of the patient, counseling costs, and whether the patient was sexually active. Sensitivity analyses with other variables did not change the results substantially. Study limitations included the effects of age on the toxicity and efficacy of highly active antiretroviral therapy, but sensitivity analyses exploring these variables did not qualitatively affect the results.
"If the tested population has an HIV prevalence of 0.1% or greater, HIV screening in persons from age 55 to 75 years reaches conventional levels of cost-effectiveness when counseling is streamlined and if the screened patient has a partner at risk," the authors conclude. "Screening patients with advanced age for HIV is economically attractive in many circumstances."