Expanded HIV Screening in the US: What Will It Cost, and Who Will Pay? A Budget Impact Analysis

Erika Martin

Abstract

_Objective_: The Centers for Disease Control and Prevention (CDC) recently revised their HIV screening 
guidelines to promote testing and earlier entry to care. Prior analyses have analyzed the policy’s 
cost-effectiveness but have not examined the impact on government budgets.

_Methods:_ We used a simulation model of HIV screening, disease, and treatment to forecast the cost 
of expanded HIV screening to government discretionary, entitlement, and testing programs. We estimated 
total and incremental testing and treatment costs over a five-year time horizon under current and 
expanded screening scenarios. We used CDC estimates of HIV prevalence and annual incidence, and 
considered a broad range of screening frequency, test return rates, linkage to care, test characteristics, 
and eligibility for government screening and treatment programs.

_Results:_ Under current practice, 177,000 new HIV cases will be identified over five years. Expanded 
screening will identify an additional 46,000 cases at an incremental cost of $2.7 billion. The financial 
burden of expanded HIV screening will fall disproportionately on discretionary programs that fund care for 
newly identified patients. Testing will represent a small fraction (18%) of the total budget increase. 
Costs are sensitive to the frequency of screening and the proportion linked to care.

_Conclusions:_ Downstream care costs and cost-shifting among government programs that finance HIV testing 
and care will be important budget concerns. Expanded HIV screening will not meet early treatment goals 
unless government programs have sufficient budgets to expand testing and provide care for newly-identified 
cases.__