The cost-effectiveness of rapid HIV testing in substance abuse treatment: Results of a randomized trial

Bruce R. Schackman, Lisa R. Metsch, Grant N. Colfax, Jared A. Leff, Angela Wong, Callie A. Scott, Daniel J. Feaster, Lauren Gooden, Tim Matheson, Louise F. Haynes, A. David Paltiel, Rochelle P. Walensky

Research output: Contribution to journalArticle

22 Scopus citations

Abstract

Background: The President's National HIV/AIDS Strategy calls for coupling HIV screening and prevention services with substance abuse treatment programs. Fewer than half of US community-based substance abuse treatment programs make HIV testing available on-site or through referral. Methods: We measured the cost-effectiveness of three HIV testing strategies evaluated in a randomized trial conducted in 12 community-based substance abuse treatment programs in 2009: off-site testing referral, on-site rapid testing with information only, on-site rapid testing with risk-reduction counseling. Data from the trial included patient demographics, prior testing history, test acceptance and receipt of results, undiagnosed HIV prevalence (0.4%) and program costs. The Cost-Effectiveness of Preventing AIDS Complications (CEPAC) computer simulation model was used to project life expectancy, lifetime costs, and quality-adjusted life years (QALYs) for HIV-infected individuals. Incremental cost-effectiveness ratios (2009 US $/QALY) were calculated after adding costs of testing HIV-uninfected individuals; costs and QALYs were discounted at 3% annually. Results: Referral for off-site testing is less efficient (dominated) compared to offering on-site testing with information only. The cost-effectiveness ratio for on-site testing with information is $60,300/QALY in the base case, or $76,300/QALY with 0.1% undiagnosed HIV prevalence. HIV risk-reduction counseling costs $36 per person more without additional benefit. Conclusions: A strategy of on-site rapid HIV testing offer with information only in substance abuse treatment programs increases life expectancy at a cost-effectiveness ratio <$100,000/QALY. Policymakers and substance abuse treatment leaders should seek funding to implement on-site rapid HIV testing in substance abuse treatment programs for those not recently tested.

Original languageEnglish (US)
Pages (from-to)90-97
Number of pages8
JournalDrug and Alcohol Dependence
Volume128
Issue number1-2
DOIs
StatePublished - Feb 1 2013

Keywords

  • Cost-effectiveness
  • Rapid HIV testing
  • Substance use

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Toxicology
  • Pharmacology
  • Pharmacology (medical)

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  • Cite this

    Schackman, B. R., Metsch, L. R., Colfax, G. N., Leff, J. A., Wong, A., Scott, C. A., Feaster, D. J., Gooden, L., Matheson, T., Haynes, L. F., Paltiel, A. D., & Walensky, R. P. (2013). The cost-effectiveness of rapid HIV testing in substance abuse treatment: Results of a randomized trial. Drug and Alcohol Dependence, 128(1-2), 90-97. https://doi.org/10.1016/j.drugalcdep.2012.08.009