Document 0375
 DOCN  M9550375
 TI    HIV screening of surgeons and dentists: a cost-effectiveness analysis.
 DT    9505
 AU    Sell RL; Jovell AJ; Siegel JE; Department of Health Policy and
       Management, Harvard School of; Public Health, Boston, MA.
 SO    Infect Control Hosp Epidemiol. 1994 Oct;15(10):635-45. Unique Identifier
       : AIDSLINE MED/95146743
 AB    OBJECTIVE: To assess the cost-effectiveness of human immunodeficiency
       virus (HIV) screening strategies of surgeons and dentists. DESIGN: We
       constructed a model to project costs and HIV transmissions prevented
       over 15 years for four screening scenarios: 1) one-time voluntary
       screening, 2) one-time mandatory screening, 3) annual voluntary
       screening, and 4) annual mandatory screening. One-time screening occurs
       only in the first year of the program; annual screening occurs once each
       year. Under mandatory screening, all practitioners are tested and risks
       of practitioner-to-patient transmission are eliminated for all
       practitioners testing positive. Voluntary screening assumes 90% of
       HIV-positive and 50% of HIV-negative practitioners are tested, and risks
       of transmission in the clinical setting are eliminated for 90% of
       HIV-positive surgeons and dentists. All costs and benefits are
       discounted at 5% per annum over 15 years. RESULTS: Using best-case
       scenario assumptions, we find for surgeons that a one-time voluntary
       screening program would be most cost-effective, at $899,336 for every
       HIV transmission prevented. For dentists, the one-time voluntary program
       also is the most cost-effective, at $139,571 per transmission prevented.
       Annual mandatory programs were least cost-effective for both surgeons
       and dentists, at $63.3 million and $2.2 million per transmission
       prevented, respectively. CONCLUSIONS: HIV screening of surgeons and
       dentists ranks among the more expensive medical lifesaving programs,
       even using liberal assumptions about program effectiveness. Frequency of
       screening and whether testing is mandatory or voluntary dramatically
       affect cost per transmission prevented; these features should be
       considered carefully in designing specific HIV screening programs.
 DE    Acquired Immunodeficiency Syndrome/*ECONOMICS/PREVENTION &
       CONTROL/TRANSMISSION  AIDS Serodiagnosis/*ECONOMICS/LEGISLATION &
       JURISPRUD  Comparative Study  Cost-Benefit Analysis  Dentists/*ECONOMICS
       Disease Transmission, Professional-to-Patient/ECONOMICS/  PREVENTION &
       CONTROL  Human  HIV Seropositivity  Mandatory
       Testing/*ECONOMICS/LEGISLATION & JURISPRUD  Models, Economic
       Sensitivity and Specificity  *Surgery  United States  JOURNAL ARTICLE

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