Document 0786
 DOCN  M9460786
 TI    The cost-effectiveness of HIV testing of physicians and dentists in the
       United States.
 DT    9404
 AU    Phillips KA; Lowe RA; Kahn JG; Lurie P; Avins AL; Ciccarone D; Center
       for AIDS Prevention Studies, School of Medicine,; University of
       California-San Francisco.
 SO    JAMA. 1994 Mar 16;271(11):851-8. Unique Identifier : AIDSLINE
       MED/94158072
 AB    OBJECTIVE--To evaluate the cost-effectiveness of alternative policies
       for human immunodeficiency testing (HIV) testing of physicians and
       dentists. METHODS--Decision analysis and cost-effectiveness analysis
       from a societal perspective were used. Data were derived from extensive
       literature review and consultation with experts. We conducted
       sensitivity analyses and also performed a cost-benefit analysis.
       ANALYSES--We analyzed policies for mandatory or voluntary testing of all
       physicians, surgeons, and dentists; for those testing positive, we
       analyzed mandatory or voluntary exclusion from practice, restriction
       from performance of invasive procedures, or requirements to inform
       patients of serostatus. MAIN OUTCOME MEASURE--Cost per patient infection
       averted. RESULTS--Although one-time mandatory testing of surgeons and
       dentists with mandatory restriction of those found to be HIV-positive is
       more cost-effective than other policies, the cost-effectiveness varies
       tremendously under different scenarios. Results were highly sensitive to
       several data inputs, especially HIV seroprevalence of surgeons and
       dentists and transmission risk. For example, under a medium
       seroprevalence and transmission risk scenario, mandatory testing of all
       surgeons might avert 25 infections at a total cost of $27.9 million or
       $1,115,000 per infection averted and an incremental cost of $291,000
       compared with current testing; however, the incremental
       cost-effectiveness per patient infection averted ranges from $29,807,000
       under a low-risk scenario to a savings of $81,000 under a high-risk
       scenario. CONCLUSION--Our analysis neither justifies nor precludes a
       mandatory testing policy. Further research on the key data inputs is
       needed. Given the ethical, social, and public health implications,
       mandatory testing policies should not be implemented without greater
       certainty as to their cost-effectiveness.
 DE    AIDS Serodiagnosis/*ECONOMICS/LEGISLATION & JURISPRUD/STANDARDS
       Cost-Benefit Analysis  Decision Support Techniques  *Dentists/STATISTICS
       & NUMER DATA/STANDARDS  Disease Transmission,
       Professional-to-Patient/ECONOMICS/  *PREVENTION & CONTROL  Health
       Policy/*ECONOMICS  Human  HIV Infections/ECONOMICS/PREVENTION &
       CONTROL/*TRANSMISSION  HIV Seroprevalence  *Physicians/STATISTICS &
       NUMER DATA/STANDARDS  Support, U.S. Gov't, P.H.S.  United States
       JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).