5053.0: Wednesday, October 24, 2001 - 9:00 AM

Abstract #25087

Cost Effectiveness of Administering a Rapid HIV Test in a High Volume Urban Infectious Disease Clinic

Robert J. Rydman, PhD1, Sabrina Kendrick2, Karen Kroc3, Robert Weinstein2, David Withum, PhD4, and Bernard Branson, MD4. (1) Department of Emergency Medicine, Cook County Hospital/Rush University, 1900 W. Polk St. 10th floor, Chicago, IL 60612, , rjrydman@uic.edu, (2) Cook County Hospital, (3) The CORE Center, Cook County Hospital, Chicago, IL, (4) CDC, Atlanta, GA

Purpose: To compare the cost outcome for and time to treatment following a rapid  (SUDS HIV-1, Abbott-Murex, Norcross, GA)  versus conventional HIV test.

 

Methods: Patients (n=1372) were age 18 plus.  All specimens received traditional EIA/WB tests (gold standard) in addition to SUDS, and SUDS diagnostic performance was calculated. Three health educators were responsible for counseling, phlebotomy, specimen testing and patient follow-up. Rapid test costs were calculated using microcosting procedures.  Costs and time to treatment were compared for the rapid test cohort and a conventionally tested historical cohort.

 

Results: The rapid test yielded: SE=97.4% (95%CI=.84); Sp=99.6% (95%CI=.11); PPV=86.0% (95%CI=1.71); NPV=99.9% (95%CI=.05); and Accuracy=99.5% (95%CI=.12).  The HIV prevalence rate was 2.7% (95%CI=.86) for the cohort (n=1372).  Patient mean processing times were 69.3 (HIV+) vs. 38.9 (HIV-) minutes.  Test unit costs were $107.71 (HIV+) vs. $40.15 (HIV-).  Total costs were $3,985.27 (HIV+) vs. $53,600.25 (HIV-); and $57,585.52 for the entire rapid test intervention.  The cost per HIV+ case detected was $1,556.36 (rapid), vs. $119 (conventional).  Proportion of test positives with treatment follow-up was 86.1% (rapid) vs. 70.4% (conventional). Test positive time to treatment was 9.6 days (rapid) vs. 54.77 days (conventional).

 

Conclusions:   Rapid HIV testing is effective, but the PPV rate could be improved.  The rapid test unit costs, and cost per positive patient are comparable to other studies reported.  The rapid test achieved a higher proportion and more timely engagement of patients in treatment thereby reducing costs related to delays in initiating treatment.

Learning Objectives: 1) Participants will understand how to compare the performance of a rapid diagnostic test to the gold standard. 2) Participants will be able to conduct cost analysis comparing two diagnostic procedures. 3) Participants will understand the importance of context of diagnostic procedures especially re: time to treatment and cost offset issues.

Keywords: Cost Issues, Epidemiology

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Abbott-Murex, SUDS HIV-1, Norcross, Ga.
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 129th Annual Meeting of APHA