Doubling the rate of HIV testing among U.S. adults over the next 5 years would lead to an additional 46,000 new diagnoses but would cost an additional $2.7 billion.

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When the Rubber Hits the Road: Paying for Expanded HIV Testing and CareDoubling the rate of HIV testing among U.S. adults over the next 5 years would lead to an additional 46,000 new diagnoses but would cost an additional $2.7 billion.In 2006, the CDC recommended expanding HIV testing in the U.S., but the recommendation was not accompanied by any increases in federal funding for testing or subsequent care. Now, researchers have used a computer simulation model to explore how expanded testing and treatment would affect U.S.

government budgets over the next 5 years.The researchers compared the current testing rate (an average of 1 test per adult every 10 years) with an expanded rate of 1 test per adult every 5 years. Their model used 2008 estimates for prevalence (1.1 million cases) and incidence (56,000 new infections per year) and assumed that 97% of newly diagnosed HIV-infected patients received their test results and that 80% were then linked to care. Drug costs were estimated based on average wholesale prices adjusted for

state Medicaid reimbursement rates.Over a 5-year horizon, the current HIV testing strategy would lead to 177,000 new HIV diagnoses. In comparison, expanded testing would lead to 223,000 new HIV diagnoses, an increase in the average CD4-cell count at diagnosis, and a decrease in the proportion of patients with AIDS at the time of HIV diagnosis. The incremental cost of expanded testing was estimated to be $2.7 billion, with 82% of that increase related to treatment costs. The cost of expanded testing would be

incurred mostly by discretionary programs (such as the White HIV/AIDS Program) and would not be offset by savings in entitlement programs (such as Medicare and Medicaid). The models were sensitive to the frequency of screening and to the proportion of patients linked to ongoing HIV care.Comment: This study highlights the downstream treatment costs of expanded HIV testing and raises serious concerns about insufficient funding of the affected government programs. The anticipated increase in

drug costs with expanded testing represents 25% of the current budget for AIDS Drug Assistance Programs, and the budget increase needed to implement expanded testing across government-financed programs is 10 times greater than the total budget increase requested by the CDC for all its HIV testing and prevention work in the next fiscal year. The current economic milieu further threatens the promise of expanded "test and treat" strategies, even though they may ultimately decrease long-term costs by improving clinical outcomes and decreasing HIV transmission rates.— Henry, MDPublished in Journal Watch HIV/AIDS Clinical CareNovember 22, 2010CITATION(S): EG et al. Expanded HIV screening in the United States: What will it cost government discretionary and entitlement programs? A budget impact analysis.Value Health 2010 Oct 15; [e-pub ahead of print]. (http://dx.doi.org/10.1111/j.1524-4733.2010.00763.x) Regards, VergelPoWeRUSA.org