TY - JOUR
KW - AIDS Serodiagnosis/economics/utilization
KW - Computer Simulation
KW - Continuity of Patient Care/statistics & numerical data
KW - Cost-Benefit Analysis
KW - Counseling/economics/utilization
KW - Decision Support Techniques
KW - HIV Infections/diagnosis/epidemiology/therapy
KW - Humans
KW - Investments/statistics & numerical data
KW - Mass Screening/economics/utilization
KW - Models, Statistical
KW - Patient Acceptance of Health Care/statistics & numerical data
KW - Prevalence
KW - Probability
KW - Quality-Adjusted Life Years
KW - Referral and Consultation/economics/utilization
KW - Resource Allocation/economics
KW - Sensitivity and Specificity
KW - United States/epidemiology
AU - R. P. Walensky
AU - M. C. Weinstein
AU - H. E. Smith
AU - K. A. Freedberg
AU - A. D. Paltiel
A1 - 
AB - BACKGROUND: Health screening programs can be represented as a pathway of sequential processes: offering a test, obtaining consent, conducting the test, providing results, and linking to appropriate care. Using the example of HIV testing, the authors explore the optimal targeting of funds within this pathway. METHODS: The authors develop a microsimulation of HIV testing services and decompose the likelihood that an unidentified HIV-infected person will receive care into the probability of testing [P(test)] and the probability of follow-up [P(follow)] defined as returning for results and linking to care. The authors examine the clinical impact and cost-effectiveness of alternative investments in these component probabilities. RESULTS: At 1% undiagnosed HIV prevalence, cost-effectiveness ratios for HIV testing cluster around $33,000/QALY (quality-adjusted life year) gained. A program with a yield of 0.16 via P(test)=0.20 and P(follow)=0.80 has a cost-effectiveness ratio of $32,900/QALY compared with $36,300/QALY for a program where P(test)=0.80 and P(follow)=0.20. Interventions that improve the probability of success in later stages in the testing pathway [P(follow)] are more cost-effective than investments devoted to earlier stages [P(test)]. CONCLUSIONS: Equivalent pathway outcomes in a screening program do not confer equal value. Limited screening resources are best targeted toward returning for results and linkage among those already identified with disease rather than offering testing to additional people.
BT - Medical decision making : an international journal of the Society for Medical Decision Making
C5 - HIT & Telehealth
CP - 3
CY - United States
DO - 10.1177/0272989X05276955
IS - 3
JF - Medical decision making : an international journal of the Society for Medical Decision Making
N2 - BACKGROUND: Health screening programs can be represented as a pathway of sequential processes: offering a test, obtaining consent, conducting the test, providing results, and linking to appropriate care. Using the example of HIV testing, the authors explore the optimal targeting of funds within this pathway. METHODS: The authors develop a microsimulation of HIV testing services and decompose the likelihood that an unidentified HIV-infected person will receive care into the probability of testing [P(test)] and the probability of follow-up [P(follow)] defined as returning for results and linking to care. The authors examine the clinical impact and cost-effectiveness of alternative investments in these component probabilities. RESULTS: At 1% undiagnosed HIV prevalence, cost-effectiveness ratios for HIV testing cluster around $33,000/QALY (quality-adjusted life year) gained. A program with a yield of 0.16 via P(test)=0.20 and P(follow)=0.80 has a cost-effectiveness ratio of $32,900/QALY compared with $36,300/QALY for a program where P(test)=0.80 and P(follow)=0.20. Interventions that improve the probability of success in later stages in the testing pathway [P(follow)] are more cost-effective than investments devoted to earlier stages [P(test)]. CONCLUSIONS: Equivalent pathway outcomes in a screening program do not confer equal value. Limited screening resources are best targeted toward returning for results and linkage among those already identified with disease rather than offering testing to additional people.
PP - United States
PY - 2005
SN - 0272-989X; 0272-989X
SP - 321
EP - 329
EP - 
T1 - Optimal allocation of testing dollars: the example of HIV counseling, testing, and referral
T2 - Medical decision making : an international journal of the Society for Medical Decision Making
TI - Optimal allocation of testing dollars: the example of HIV counseling, testing, and referral
U1 - HIT & Telehealth
U3 - 10.1177/0272989X05276955
VL - 25
VO - 0272-989X; 0272-989X
Y1 - 2005
ER -