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PURPOSE: The Centers for Disease Control and Prevention’s "Guidance for HIV Partner Counseling and Referral Services"(PCRS) defined 3 different strategies to notify persons who may have been exposed to HIV infection: (1) provider – the health provider notifies partners; (2) patient – the index patient notifies partners and (3) mixed – the index patient, assisted by the provider, notifies partners. Despite the fact that PCRS has been found to be cost saving to society, there is still concern about the costs, particularly for provider PCRS, among public health decision makers. We therefore compared the costs and effectiveness of the 3 strategies.
METHODS: We developed a probabilistic decision model to calculate costs and effectiveness. To the determine effectiveness of the PCRS strategies, we conducted a systematic review of the literature from 1990-2003. Cost and resource utilization data were obtained from health departments, national wage data and the literature. The analysis was conducted from the societal and program perspectives. We performed univariate and multivariate sensitivity analyses using Monte Carlo simulation to ascertain the robustness of the base-case results.
RESULTS: Data from 8 studies were pooled for provider PCRS effectiveness parameters and 2 studies provided data on mixed and patient PCRS strategies. Notification and testing rates were 68% and 63% (provider), 62% and 48% (mixed) and 32% and 50% (patient). The newly identified HIV seropositivity rate was approximately 20% for all strategies. The mean per person cost of PCRS ranged from $152 (patient) to $253 (provider) from the societal perspective and $125 (patient) to $212 (provider) from the program perspective. Provider PCRS was most cost-effective and patient PCRS was least cost-effective from both perspectives. The mixed PCRS strategy was eliminated through extended dominance. The incremental cost per newly identified HIV-infected person with provider notification was $1,750 (95% CI: $1737-$1764) from the societal perspective and $1,515 (95% CI: $1503-$1527) from the program perspective. From the societal perspective, sensitivity analysis did not appreciably alter results; however, changing some of the effectiveness parameters to their lowest values for sensitivity analysis made the mixed strategy more cost-effective from the program perspective.
CONCLUSIONS: PCRS, particularly provider PCRS, is an effective method of identifying HIV infection in persons who may have been exposed. Provider PCRS should be favored when considering both cost and effectiveness.
See more of Poster Session - Public Health; Methodological Advances
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)