The president's fiscal year 2007 initiative for human immunodeficiency virus counseling and testing expansion in the United States: A scenario analysis of its coverage, impact, and cost-effectiveness

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Abstract

INTRODUCTION: When adjusted for inflation, the federal investment in human immunodeficiency virus (HIV) prevention in the United States has been trending downward for several years. However, for fiscal year 2007, President Bush has proposed to Congress a $93 million increase in HIV prevention efforts focused on HIV counseling and rapid testing in high-risk communities. OBJECTIVE: Here, we estimate the coverage level of an investment of $93 million for rapid testing and counseling services, estimate the number of HIV infections that might be expected to be prevented by this initiative, and calculate the cost-per-infection-prevented. METHODS: Standard methods of scenario and cost-effectiveness analysis were employed, and a 1-year time horizon was used. Calculations were done assuming both a societal perspective and a payor perspective. RESULTS: Assuming full societal perspective costs, about 1.4 million clients could be reached, but if the payor's perspective is used (and clients are assumed to absorb the costs of their time spent and transportation), then coverage could expand to 2.9 million clients. Depending on the perspective used, it is estimated that between 13,014 and 26,984 persons living with HIV could newly learn their serostatus, and that between 1,223 and 2,537 HIV infections could be prevented as a function of the initiative. Under both societal and payor perspectives, the gross cost per infection averted is less than the medical care costs for one case of HIV disease. CONCLUSIONS: We conclude that the president's proposed $93 million initiative for HIV counseling and rapid testing in the United States would have favorable public health benefits and be cost saving to society (even if it does not address all unmet HIV prevention needs in the United States). However, future research should seek to determine whether rapid counseling and testing are the optimal use of a new $93 million investment in HIV prevention.

Original languageEnglish (US)
Pages (from-to)239-243
Number of pages5
JournalJournal of Public Health Management and Practice
Volume13
Issue number3
DOIs
StatePublished - May 2007

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Cost-Benefit Analysis
Counseling
HIV
Virus Diseases
Costs and Cost Analysis
Health Care Costs
Economic Inflation
Insurance Benefits
Infection
Public Health

Keywords

  • Counseling
  • Economic evaluation
  • HIV
  • Prevention
  • Scenario analysis
  • Testing

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Health Policy

Cite this

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title = "The president's fiscal year 2007 initiative for human immunodeficiency virus counseling and testing expansion in the United States: A scenario analysis of its coverage, impact, and cost-effectiveness",
abstract = "INTRODUCTION: When adjusted for inflation, the federal investment in human immunodeficiency virus (HIV) prevention in the United States has been trending downward for several years. However, for fiscal year 2007, President Bush has proposed to Congress a $93 million increase in HIV prevention efforts focused on HIV counseling and rapid testing in high-risk communities. OBJECTIVE: Here, we estimate the coverage level of an investment of $93 million for rapid testing and counseling services, estimate the number of HIV infections that might be expected to be prevented by this initiative, and calculate the cost-per-infection-prevented. METHODS: Standard methods of scenario and cost-effectiveness analysis were employed, and a 1-year time horizon was used. Calculations were done assuming both a societal perspective and a payor perspective. RESULTS: Assuming full societal perspective costs, about 1.4 million clients could be reached, but if the payor's perspective is used (and clients are assumed to absorb the costs of their time spent and transportation), then coverage could expand to 2.9 million clients. Depending on the perspective used, it is estimated that between 13,014 and 26,984 persons living with HIV could newly learn their serostatus, and that between 1,223 and 2,537 HIV infections could be prevented as a function of the initiative. Under both societal and payor perspectives, the gross cost per infection averted is less than the medical care costs for one case of HIV disease. CONCLUSIONS: We conclude that the president's proposed $93 million initiative for HIV counseling and rapid testing in the United States would have favorable public health benefits and be cost saving to society (even if it does not address all unmet HIV prevention needs in the United States). However, future research should seek to determine whether rapid counseling and testing are the optimal use of a new $93 million investment in HIV prevention.",
keywords = "Counseling, Economic evaluation, HIV, Prevention, Scenario analysis, Testing",
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year = "2007",
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T1 - The president's fiscal year 2007 initiative for human immunodeficiency virus counseling and testing expansion in the United States

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AU - Holtgrave, David R

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N2 - INTRODUCTION: When adjusted for inflation, the federal investment in human immunodeficiency virus (HIV) prevention in the United States has been trending downward for several years. However, for fiscal year 2007, President Bush has proposed to Congress a $93 million increase in HIV prevention efforts focused on HIV counseling and rapid testing in high-risk communities. OBJECTIVE: Here, we estimate the coverage level of an investment of $93 million for rapid testing and counseling services, estimate the number of HIV infections that might be expected to be prevented by this initiative, and calculate the cost-per-infection-prevented. METHODS: Standard methods of scenario and cost-effectiveness analysis were employed, and a 1-year time horizon was used. Calculations were done assuming both a societal perspective and a payor perspective. RESULTS: Assuming full societal perspective costs, about 1.4 million clients could be reached, but if the payor's perspective is used (and clients are assumed to absorb the costs of their time spent and transportation), then coverage could expand to 2.9 million clients. Depending on the perspective used, it is estimated that between 13,014 and 26,984 persons living with HIV could newly learn their serostatus, and that between 1,223 and 2,537 HIV infections could be prevented as a function of the initiative. Under both societal and payor perspectives, the gross cost per infection averted is less than the medical care costs for one case of HIV disease. CONCLUSIONS: We conclude that the president's proposed $93 million initiative for HIV counseling and rapid testing in the United States would have favorable public health benefits and be cost saving to society (even if it does not address all unmet HIV prevention needs in the United States). However, future research should seek to determine whether rapid counseling and testing are the optimal use of a new $93 million investment in HIV prevention.

AB - INTRODUCTION: When adjusted for inflation, the federal investment in human immunodeficiency virus (HIV) prevention in the United States has been trending downward for several years. However, for fiscal year 2007, President Bush has proposed to Congress a $93 million increase in HIV prevention efforts focused on HIV counseling and rapid testing in high-risk communities. OBJECTIVE: Here, we estimate the coverage level of an investment of $93 million for rapid testing and counseling services, estimate the number of HIV infections that might be expected to be prevented by this initiative, and calculate the cost-per-infection-prevented. METHODS: Standard methods of scenario and cost-effectiveness analysis were employed, and a 1-year time horizon was used. Calculations were done assuming both a societal perspective and a payor perspective. RESULTS: Assuming full societal perspective costs, about 1.4 million clients could be reached, but if the payor's perspective is used (and clients are assumed to absorb the costs of their time spent and transportation), then coverage could expand to 2.9 million clients. Depending on the perspective used, it is estimated that between 13,014 and 26,984 persons living with HIV could newly learn their serostatus, and that between 1,223 and 2,537 HIV infections could be prevented as a function of the initiative. Under both societal and payor perspectives, the gross cost per infection averted is less than the medical care costs for one case of HIV disease. CONCLUSIONS: We conclude that the president's proposed $93 million initiative for HIV counseling and rapid testing in the United States would have favorable public health benefits and be cost saving to society (even if it does not address all unmet HIV prevention needs in the United States). However, future research should seek to determine whether rapid counseling and testing are the optimal use of a new $93 million investment in HIV prevention.

KW - Counseling

KW - Economic evaluation

KW - HIV

KW - Prevention

KW - Scenario analysis

KW - Testing

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