Medical Device Daily Washington Editor

Two multi-center research teams at the National Institutes of Health (NIH; Bethesda, Maryland) independently have determined through the development of computer models that routine screening for HIV is as cost-effective as screening for other conditions such as breast cancer and high blood pressure and can provide key health and survival benefits.

The studies also suggest that screening that leads to a diagnosis of HIV infection may further lower healthcare costs by preventing high-risk practices and decreasing virus transmission, according to the NIH.

Both studies — one led by Gillian Sanders, MD, at Duke University's (Durham, North Carolina) Duke Clinical Research Institute, and Douglas Owens at the Veterans Affairs Palo Alto Health Care System (Palo Alto, California); the other led by A. David Paltiel, MD, at Yale School of Medicine (New Haven, Connecticut) — were published in the Feb. 10 issue of the New England Journal of Medicine.

Of the nearly 1 million people in the U.S. infected with HIV, about 280,000 are unaware of their status, according to NIH, and current patterns of screening are inconsistent, with people generally diagnosed late in their disease.

The studies' findings are that by expanding screening, people identified with HIV can begin medical therapy earlier and improve their quality of life, and they may reduce high-risk behaviors that result in transmitting the virus.

“As part of the study, we analyzed the costs associated with HIV testing, counseling, follow up and treatment,“ Sanders said. “While no computer model is a perfect representation of reality, the results suggest that a one-time HIV screening program provides a very important health benefit and is a good value, even in populations with a relatively low proportion of people with HIV.“ He estimated a one-time screening costing about $15,078 for every year of life gained, “a figure that takes into account the resulting reduction in virus transmission and benefits to partners.“

The researchers also found that a one-time screening program could reduce the annual HIV transmission rate over these patients' lifetimes by 21% compared to current practice.

In the second study, a computer model was used to compare costs associated with HIV screening and current voluntary HIV diagnostic and counseling practices in three populations: a high-risk population in which 3% had undiagnosed HIV infection, a population where 1% had undiagnosed HIV, and the general population in which the prevalence of undiagnosed HIV was 0.1%.

Routine, voluntary HIV screening every three to five years would provide clinical benefits and is cost-effective in all but the lowest-risk populations, the research found. One-time screening in the general U.S. population also may be cost-effective.

According to the NIH, data from other cost-effectiveness studies show that screening for Type 2 diabetes costs around $56,600 per quality-adjusted life year gained, while screening costs for high blood pressure and colorectal cancer cost $48,000 and $51,200, respectively.

Further research is necessary, the researchers said, to determine the best ways to implement HIV screening, how to reduce barriers to screening, how to increase the effects of counseling on patient knowledge and the cost-effectiveness of HIV screening in the elderly.

Florida to pilot Internet Information Rx

A pilot program launched Monday in Florida is encouraging physicians to direct patients online to stay on top of their healthcare concerns. The online sites to be “prescribed“ are the National Library of Medicine's MedlinePlus database (www.medlineplus.gov) and Fisher Center Foundation's web site (www.alzinfo.org). Spearheading the program are the Fisher Center for Alzheimer's Research Foundation (New York) and the NIH's National Library of Medicine (NLM).

Called the Information Rx project, the pilot program was launched with a demonstration hosted by Rep. C. W. Bill Young (R-Florida). “Used properly, the Internet can be another important healthcare tool, just like the biopsy, the X-ray and the electrocardiogram,“ he said.

Young called MedlinePlus “the gold standard“ for consumer health information. “I think [patients will] find that, used in conjunction with their doctor's good care, information can be powerful medicine,“ he said. According to the NIH, 80% of U.S. adults use the Internet for health information, and 70% of those surveyed in a recent study said they would pay “serious attention“ to a physician-recommended web site.

“Part of a physician's job is to explain illnesses, diagnoses and treatment to their patients,“ said Cecil Wilson, MD, member of the board of trustees of the American Medical Association (Chicago), saying that MedlinePlus provides information that is “authoritative, user-friendly and commercial-free.“

The program is intended to improve health literacy and patient education by combining high-quality sources of consumer health and Alzheimer's disease information with the interpersonal intervention and encouragement of a trusted medical provider. An expanded national initiative is expected to follow pilot program testing.

The web site, also available in Spanish, has information on more than 700 topics, from other partnering public and private healthcare sites.

An Information Rx project already has been under way with internal medicine physicians in Iowa, Georgia and Virginia. According to the NIH, so far 97% of participating physicians make referrals to MedlinePlus, and a majority uses it daily.