Wednesday, June 18, 2008

Screening older patients for HIV can be a cost-effective health tool
By Kelly Winget

Most HIV screening efforts have focused on patients younger than 45 years old, but recently the Centers for Disease Control and Prevention (CDC) recommended that all patients between 13 and 64 years old should be screened for HIV in health care settings, as there are a growing number of infections that occur in older people. A new study, led by the DCRI's Gillian Sanders, PhD, evaluated the cost-effectiveness of conducting screenings and counseling for patients between 55 and 75 years old.

The study was published in the June 17 issue of Annals of Internal Medicine.

Previous studies have found that screening for HIV for patients 40 years old and younger is cost-effective in terms of quality adjusted life-years (QALY), even in areas where there is not a high prevalence of HIV cases. However, almost 19% of people living with AIDS in the U.S. were at least 50 years old when they were first diagnosed, so screening people in this age group is becoming more vital.

Researchers were concerned about the possible cost-effectiveness of screening patients over the age of 55 for several reasons. HIV is less prevalent in this age group, which could lower the cost-effectiveness. Treatment for this patient age group could also be more costly because there are likely other competing health risks which would diminish the overall benefits of HIV therapy. Another concern was that if patients older than 55 have fewer sexual partners, screening could become less economically attractive, since reducing HIV is an important benefit of screening. There have also not been many studies on the effectiveness or possible toxicity of highly active antiretroviral therapy for patients older than 55 years old, so there might not be as many benefits that younger patients receive.

To determine cost-effectiveness, researchers estimated the health and economic effects of a voluntary HIV screening program for people between the ages of 55 and 75, following the recommendations of the Panel on Cost-Effectiveness in Health and Medicine. They applied a societal perspective on health benefits and costs.

The study found that screening for patients in this age group is most cost-effective if providers incorporate streamlined counseling as part of the screening process, and if the person who is being screened has a sexual partner at risk for infection. Screening becomes more expensive among patients who do not have a partner at risk or if traditional counseling is used instead of the more streamlined counseling approach.

Based on the study findings, researchers recommend routine, one-time voluntary HIV screenings with streamlined counseling for all patients between the ages of 55 and 64 years old, and one-time screening on a targeted basis for sexually active patients between the ages of 65 and 74 years old, but only in areas where there is a greater prevalence of HIV infections. Researchers determined that screening patients between the ages of 65 and 74, that while important, is less cost-effective if the patients are not sexually active or if they have other existing health risks.