Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-28T04:51:53.110Z Has data issue: false hasContentIssue false
  • English
  • Français

HIV Screening of Surgeons and Dentists: A Cost-Effectiveness Analysis

Published online by Cambridge University Press:  02 January 2015

Randall L. Sell ,
Albert J. Jovell  and
Joanna E. Siegel
Randall L. Sell*
Affiliation:
Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts Department of Health and Social Behavior, Harvard School of Public Health, Boston, Massachusetts
Albert J. Jovell
Affiliation:
Department of Health and Social Behavior, Harvard School of Public Health, Boston, Massachusetts
Joanna E. Siegel
Affiliation:
Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
*
435 Shawmut Ave., Boston, MA 02118
Get access Rights & Permissions [Opens in a new window]

Abstract

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 15 , Issue 10 , October 1994 , pp. 635 - 645
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Centers for Disease Control. Possible transmission of human immunodeficiency virus to a patient during an invasive dental procedure. MMWR 1990;39:489–493.Google Scholar
2.Centers for Disease Control. Update: transmission of HIV infection during invasive dental procedures-Florida. MMWR 1991;40:21–27.Google Scholar
3.Centers for Disease Control. Update: investigations of persons treated bv HIV-infected health-care workers-United States. MMWR 1993;42:329–337.Google Scholar
4.Sixth AIDS case traced to Florida dentist. Science 1993;260:897.Google Scholar
5.Glantz, LH. Mariner, WK. Annas, GT. Risky business: setting public health policy for HIV-infected” health care professional: Milbank Q 1992;70(1):43–79.CrossRefGoogle Scholar
6.U.S. Congress, Office of Technology Assessment. HIV in the Health Care Workplace. OTA-BP-H-90. Washington, DC: U.S. Government Printing Office; November 1991.Google Scholar
7.Centers for Disease Control. Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures. MMWR 1991;40:1–9.Google Scholar
8.Lo, B, Steinbrook, R, Health care workers infected with the human immunodeficiency virus. JAMA 1992;267:1100–1105.CrossRefGoogle ScholarPubMed
9.National Commission on AIDS. Preventing HIV Transmission in Health Care Settings. Washington, DC: National Commission on AIDS; July. 1992.Google Scholar
10.Bell, DM, Curran, JW. Human immunodeficiency virus. In: Bennett, JV, Brachman, PS, eds. Hospital Infections. 3rd ed. Boston, MA: Little. Brown and Co: 1992.Google Scholar
11.Craven, DE. Serologic diagnosis. In: Libman, H, Witzburg, RA, eds. Clinical Manual for Care of the Adult Patient with HIV Infection. Boston, MA: Department of Medicine, Boston City Hospital; 1990.Google Scholar
12.Satten, GA, Longini, I, Clark, WS. Estimating the incidence of HIV infection using cross-sectional Markov surveys. Presented at the Eighth International Conference on AIDS; July 21, 1992; Amsterdam, The Netherlands. Abstract PoB 3894.Google Scholar
13.Hellinger, FJ. The lifetime cost of treating a person with HIV JAMA 1993;270:474–478.Google Scholar
14.Hedlund, K, Spencer, J, Schalla, W, et al. Estimated public costs of HIV counseling and testing, USA Presented at the Sixth International Conference on AIDS; June 20-24, 1990; San Francisco, California. Abstract.Google Scholar
15.Weinstein, MC, Graham, JD, Siegel, JE, et al. Cost-effectiveness analysis of AIDS prevention programs: concepts, complications, and illustrations. In: AIDS: The Second Decade. Washington, DC: National Academy Press; 1990.Google Scholar
16.Ciesielski, CA, Bell, DM, Marianor, DW. Transmission of HIV from infected health-care workers to patients. AIDS 1991:5(suppl 2):S93–S97.Google Scholar
17.Health Resources and Services Administration. Seventh Report to the President and Congress on the Status of Health Personnel in the United States. Washington, DC: U.S. Department of Health and Human Services. DHHS publication no. HRS-P-OD-90-1.Google Scholar
18.American Dental Association. Dental Manpower Model. Bureau of Economic and Behavioral Research; May 1991Google Scholar
19.Rowley, BD, Baldwin, DC, McGuire, MB. Selected characteristics of graduate medical education in the United States. JAMA 1991;266:933–942.Google Scholar
20.Centers for Disease Control. Preliminary analysis: HIV serosurvey of orthopedic surgeons, 1991. MMWR 1991;40:309–312.Google Scholar
21.Tokars, JI, Chamberland, ME, Sellable, CA, et al. The American Academy of Orthopaedic Surgeons Serosurvey Study Committee. A survey of occupational blood contact and HIV infection among orthopedic surgeons. JAMA 1992;268:489–494.Google Scholar
22.Hirsch, RI? Berry, ZS. Glover, II. Voluntary HIV testing among Washington, DC, area physic&s. Presented at the 5th National Forum on AIDS, Hepatitis, and Other Blood-Borne Diseases; March 29-April 1, 1992; Atlanta, Georgia. Abstract.Google Scholar
23.Schwartz, JS, Kinosian, BPPierskalla, WP, Lee, H. Strategies for screening blood for human immunodeficiency virus antibody. JAMA 1990;264:1704–1710.CrossRefGoogle ScholarPubMed
24.Cleat-y, PD, Barry, MJ, Mayer, KH, et al. Compulsory premarital screening for the human immunodeficiency virus: technical and public health considerations. JAMA 1987;258:1757–1762.Google Scholar
25.Centers for Disease Control HIV prevalence estimates and AIDS case projections for the United States: report based upon a workshop. MMWR 1990;39:1–31.Google Scholar
26.Dickey, NW. HIV Transmission During Invasive Procedures. Statement of the American Medical Association to the Centers for Disease Control; February 21, 1991; Chicago, Illinois.Google Scholar
27.Painter, JT.AMA 1990 HIV Policies. Report of the Board of Trustees 1990. Chicago, IL: American Medical Association; 1990. Report RR(I-90).Google Scholar
28. Centers for Disease Control. Estimates of the Risk of Endemic Transmission of Hepatitis B Virus and Human Immunodeficiency Virus to Patients by the Percutaneous Route During Invasive Surgical and Dental Procedures. Draft Report. Atlanta, GA: Centers for Disease Control; January 30, 1991:1–18.Google Scholar
29.Warner, KE. Luce, BRCost-Benefit and Cost-Effectiveness Analvsis in Health Care: Principles, Practice, and Potential. Ann Arbor, MI: Health Administration Press; 1982.Google Scholar
30.Phillips, KA, Lowe, RA, Kahn, JG, et al. The cost-effectiveness of HIV testing of physicians and dentists in the United States. JAMA 1994;271:851–858.CrossRefGoogle ScholarPubMed
31.Eisenstaedt, RS, Getzen, TE. Screening blood donors for human immunodeficiency virus antibody: cost-benefit analysis. Am J Public Health 1988;78:450–454.Google Scholar
32.Mendelson, DN, Sandler, SG. A model for estimating incremental benefits and costs of testing donated blood for human immunodeficiencyvirus antigen (HIV-Ag). Transfusion 1990;30:73–75.Google Scholar
33.McKay, NL, Phillips, KM. An economic evaluation of mandatory premarital testing for HIV Inquiry 1991;28:236–248.Google Scholar
34.Stock, SR, Gafni, A, Bloch, RF. Universal precautions to prevent HIV transmission to health care workers: an economic analysis. Can Med Assoc J 1990;142:937–946.Google ScholarPubMed
35.Russo, G, La Croix, SJ. A second look at the cost of mandatory human immunodeficiency virus and hepatitis B virus testing for healthcare workers performing invasive procedures. Infect Control Hosp Epidemiol 1992;13:107–110.CrossRefGoogle ScholarPubMed
36.Gerberding, JL. Expected costs of implementing a mandatory human immunodeficiency virus and hepatitis B virus testing and restriction program for healthcare workers performing invasive procedures. Infect Control Hosp Epidemiol 1991;12:443–447.CrossRefGoogle ScholarPubMed