HIV SCREENING OF SURGEONS AND DENTISTS - A COST-EFFECTIVENESS ANALYSIS

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 o ver 15 years for four screening scenarios: 1) one-time voluntary scree ning, 2) one-time mandatory screening, 3) annual voluntary screening, and 4) annual mandatory screening. One-time screening occurs only in t he first year of the program; annual screening occurs once each year. Under mandatory screening, all practitioners are tested and risks of p ractitioner-to-patient transmission are eliminated for all practitione rs testing positive. Voluntary screening assumes 90% of HIV-positive a nd 50% of HIV-negative practitioners are tested, and risks of transmis sion in the clinical setting are eliminated for 90% of HIV-positive su rgeons and dentists. All costs and benefits are discounted at 5% per a nnum over 15 years. RESULTS: Using ''best-case'' scenario assumptions, we find for surgeons that a one-time voluntary screening program woul d be most cost-effective, at $899,336 for every HIV transmission preve nted. For dentists, the one-time voluntary program also is the most co st-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, respective ly. CONCLUSIONS: HIV screening of surgeons and dentists ranks among th e more expensive medical lifesaving programs, even using liberal assum ptions about program effectiveness. Frequency of screening and whether testing is mandatory or voluntary dramatically affect cost per transm ission prevented; these features should be considered carefully in des igning specific HIV screening programs (Infect Control Hosp Epidemiol 1994;635-645).