OBJECTIVES: The CDC recommends routine universal HIV testing in all health-care settings. A universal screening program screens all patients unless they choose to opt-out, while a targeted screening considers only patients with high risk behaviors for contracting HIV. This study aims to perform a cost-effectiveness analysis of a universal versus targeted HIV screening approach to identify new HIV diagnoses in the ED setting.

METHODS: A decision tree was developed using TreeAge Pro to compare the cost-effectiveness ratios of universal vs. targeted screening for detecting new HIV positive patients. The analysis was performed from the provider perspective over a lifetime horizon. Universal screening effectiveness data was obtained from two Jefferson Health Hospitals in Philadelphia from 2015-2016. Targeted screening effectiveness data, test costs, and staff costs were obtained from the literature. Effectiveness of the approach was reported as the number of new HIV cases diagnosed. Costs were inflated to 2017 USD. Model outcome was expressed as incremental cost effectiveness ratio (ICER). One-way sensitivity analysis was performed.

RESULTS: The percentage of ED patients tested in the universal and targeted screening approach was 31% and 3%, respectively. The costs for the point of care, multispot and viral load tests were $10.17, $33.19, and $120.62, respectively. The universal and targeted screening approaches diagnosed 65 (0.396%) and 35 (0.941%) patients, respectively. The ICER was estimated at $17,759, which represents the cost required to identify one additional case of HIV in the universal screening approach compared to the targeted approach.

CONCLUSIONS: Although the incremental cost of identifying a new HIV case is higher when using a universal screening approach. To justify this cost, providers should consider potential benefits associated with earlier detection and long-term cost savings compared to an undiagnosed case of HIV or late stage diagnosis.