A Cost-Benefit Analysis of HIV-Antibody Testing For Hospital Patients

Objectives- To develop a full taxonomy of potential benefits of HIV testing of hospital patients. To determine whether voluntary, routine testing of hospital patients for HIV is warranted under a cost-benefit criterion. To inform healthcare workers, hospital patients, and decision makers responsible for testing programs of the potential net benefits of routine testing. Design- Benefits stemming from information about a patient's HIV serostatus may accrue to (1) healthcare workers if extra precautions significantly reduce their HIV-exposure rate; (2) the patient if knowledge of HIV serostatus enables the patient to take prophylactic measures to extend life expectancy; and (3) the patient's sex partners if the patient is less likely to transmit HIV after undergoing hospital HIV testing. Methods- 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 testing is specified by the reported cost of an HIV-testing protocol and pre- and post-test counseling. Results- Voluntary, routine HIV testing of hospital patients passes our cost-benefit test when benefits to the patient, to attending healthcare workers, and to the patient's sex partners are jointly considered. Information about a patient's HIV serostatus provides very small expected benefits to healthcare workers ($.34) because risk of transmission is small; taken alone benefits to healthcare workers would not warrant routine HIV testing even in high HIV-prevalence hospitals. Information about a patient's HIV serostatus provides relatively large expected benefits to the patient ($15,671) because of the availability of life extending treatment and to the patient's sex partners ($4,918) because the risk of transmission can be reduced by adopting safer sex practices. Conclusion- Routine, voluntary HIV testing programs in hospitals pass our cost-benefit test even in relatively low HIV-prevalence hospitals. Mandatory HIV testing in hospitals is, however, not recommended, as the potential exists for third-parties (employers, insurers, healthcare workers) to use the test to impose costs on HIV-seropositive patients. Since most benefits derived from information on the patient's HIV serostatus are realized by the HIV-seropositive patient obtaining prophylactic treatment and by the patient eliminating or reducing high-risk sexual behaviors, HIV-testing programs should be formulated to emphasize careful, effective, pre- and post-test patient counseling concerning the existence of potential benefits and reasonable plans for realizing them.