Session: Health Economics and Decision Analysis at the U.S. Centers for Disease Control and Prevention
Room: Phillips 203
Time: Wed 10:15-11:45

Presenter: Ram Shrestha (Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention)

Discussant: Martey DodooAmerican Academy of Family Physicians

Abstract

The Centers for Disease Control and Prevention (CDC) estimates that approximately 1.1 million people in the United States are infected with HIV, and 21% of them are unaware of their infection, making them much more likely to engage in unsafe sexual and needle-sharing activities and unknowingly transmit HIV to their partners. To increase the number of people who know their HIV serostatus, CDC launched Advancing HIV Prevention (AHP) demonstration projects in 2003. The projects aimed to reduce barriers to early diagnosis of HIV infection among high-risk populations by offering HIV counseling and testing in non-health-care settings, including jails, community-based organizations (CBOs) and venues frequented by high-risk individuals, and through partner services and social networks of HIV-positive and high-risk HIV-negative persons. Accurate estimation of the costs of testing in these settings is essential for efficient allocation of HIV testing resources. Three methods to estimate HIV counseling and testing costs were compared based on data from the demonstration projects. The costs and cost-effectiveness of 5 different HIV counseling and testing interventions implemented in 14 sites between October 2003 and December 2006 was assessed. Microcosting methods were employed to assess all fixed and variable costs including those attributable to staff time, training, travel, incentives to clients, facility space, utilities, equipment, test kits, and supplies. Standardized forms were used to collect cost data, and estimated most of the personnel costs retrospectively by tracking staff time spent on specific program activities. The microcosting results were compared with two other costing methods: gross-costing, where the personnel cost was derived from the overall proportion of staff time spent on HIV counseling and testing interventions, as reported by program administrators; and program funding, where the program cost was assumed to be the total funding provided by CDC. Costs were expressed in 2007 US dollars. Results are presented based on annual average costs and outcomes. The median total cost of 14 HIV counseling and testing interventions was $145,095, $200,429, and $234,293, based on microcosting, gross-costing, and program funding methods, respectively. The median cost per new HIV diagnosis and notification was $11,856, $16,631, and $19,727, respectively. Compared to microcosting, the gross-costing and program funding methods were associated with 46% and 90% higher costs. Microcosting methods attempt to account for all resources used in an intervention, and no additional resources. However, microcosting assumes the divisibility of all inputs, including staff time, and thus may represent minimum costs. While gross-costing and program funding methods are attractive in terms of their simplicity, they may overstate costs.

Key Terms

HIV, Microcosting, “Cost-effectiveness,” “Counseling and Testing”

Authors:

Ram Shrestha (CDC. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention)