Method: We compared three HIV testing strategies offered in the following scenarios: 1) traditional HIV pre-test/post-test counseling (in absence of clinical reminder), 2) both pre-test/post-test counseling and new strategy utilizing clinical reminders in the VA healthcare system, and 3) only clinical reminders (in absence of pre-test/post-test counseling) . Based on literature and patient records in health center, we modeled a hypothetical population and simulated cost and effectiveness. A payer-perspective decision model was conducted to calculate the 1-year budget impact of the HIV testing strategies. Parameter values were obtained from the literature, including patients’ probability of accepting test, and costs associated with HIV testing procedures. De-identified patient data, including total population screened and number of new HIV cases, was collected from one clinic in Los Angeles, CA, from August 2004 to December 2011. Annual total costs and costs per new case were calculated based on parameter values and patient data. Sensitivity analyses were conducted to evaluate the robustness of the critical variable on costs.
Result: The total cost of clinical reminder system with shortened pre-test counseling was $81, 726.57 over one year compared to $109,208.98 for traditional HIV testing. Under a clinical reminder system with no pre-test counseling, the outcomes showed a greatly increased in the number of HIV tests performed and number of new diagnoses for that year. In addition, cost per new diagnoses was the lowest in the health setting scenario with only clinical reminder.
Conclusion:
The strategy utilizing the clinical reminder system reduced the cost per cased identified and promoted the performance of HIV testing, compared with traditional HIV testing. The fundamental decision model can be used for hospital facilities outside the Veteran Affairs adopting a similar program for improving HIV testing rate.