Purpose: In 2006, CDC recommended routine HIV testing for all adult Americans. While prior analyses have demonstrated this recommendation's cost-effectiveness, affordability concerns remain an obstacle to widespread implementation.
Method: We conducted a 5-year Budget Impact Analysis for government programs using the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) Model, a simulation of HIV disease, detection and care. We estimated the incremental screening and treatment costs of increasing average test frequencies from every 10 years (current practice) to every 5 years. We used CDC estimates of HIV prevalence (1.1 million) and annual incidence (56,000). We considered a broad range of screening frequency (no screening to annual screening), test return rates (50%-100%), linkage to care (50%-100%), test characteristics, and eligibility for government-funded discretionary (e.g. Ryan White), entitlement ( Medicaid and Medicare), and screening programs.
Result: Under current practice, 177,000 new HIV cases will be identified in the US over 5 years. Expanded screening would identify an additional 46,000 cases at an incremental cost to government programs of $2.4 billion. These costs would fall primarily on discretionary programs, while conferring small savings to entitlement programs (see figure). Screening programs would incur 19% of the total budget increase. Costs are sensitive to the frequency of screening and the proportion linked to care.
Conclusion: Greater coordination is required among CDC, Medicaid, Medicare, and discretionary program payer agencies to ensure that resources are available to finance downstream care costs for newly-identified HIV cases. 