Sensitivity of incremental cost-effectiveness ratio (vertical axis) to alternative undetected HIV prevalences (horizontal axis).

<p>The incremental cost-effectiveness of the <i>Provider</i> strategy, compared to <i>No Screen</i>, is shown by the open circles. The incremental cost-effectiveness of the <i>Counselor</i> strategy, compared to the <i>Provider</i> strategy is provided by the closed squares. The dashed line (open circles) is the incremental cost-effectiveness of the <i>Provider</i> strategy, compared to <i>No Screen</i>, at half the base case provider-based screening costs ($4.05/result received). The dashed line (solid squares) is the incremental cost-effectiveness of <i>Counselor</i> strategy, compared to the <i>Provider</i> strategy, at twice the base case counselor-based screening costs ($62.00/result received).</p

Resource utilization and costs from the USHER Trial Counselor Arm.

<p>SD: Standard deviation.</p><p>*The estimate was obtained by dividing the annual counselor salary by the number of patients per year per counselor receiving test results in the counselor arm. We have intentionally applied a conservative calculation of the cost per result received in the counselor arm, by accounting for all counselor downtime.</p>†<p>Costs in this column are exclusive of downtime; this column multiplies the mean time per patient by the cost per minute of a counselor. This column is shown simply for comparison to the provider strategy and is not used in the cost-effectiveness analysis.</p

Base case cost-effectiveness analyses of <i>Counselor</i> vs. <i>Provider</i> strategies.

<p>QALE: Quality-adjusted life expectancy, QALY: quality-adjusted life year.</p><p>*Cost-effectiveness ratios using discounted per person lifetime costs and discounted per person QALE were calculated prior to rounding.</p>†<p>“dominated” strategies are eliminated because they cost more and deliver fewer years of life saved than the comparative combination of strategies <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0025575#pone.0025575-Gold1" target="_blank">[11]</a>.</p

Resource utilization and costs from the USHER Trial Provider Arm.

<p>SD: Standard deviation.</p><p>*Obtained from Brigham and Women's Hospital, Emergency Department budgets.</p>†<p>Based on average salaries post-graduate year 1–4 emergency medicine resident salaries for the 2008–2009 academic year; assumes a 60-hour resident work week.</p>‡<p>Based on median BWH attending physician salary in calendar year 2008; assumes a 50-hour attending work week. Results are consistent with AAMC northeast region, emergency medicine 2008 average, when weighted by academic rank <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0025575#pone.0025575-Association1" target="_blank">[36]</a>.</p

Sensitivity of incremental cost-effectiveness ratio (vertical axis) to HIV testing program coverage (horizontal axis).

<p>The squares provide the cost-effectiveness of the <i>Counselor</i> strategy compared to the <i>Provider</i> strategy at alternative rates of counselor-based program coverage; provider participation is held constant at its base case value (27%). Counselor-based testing is cost-effective at a ratio of <$100,000/QALY so long as counselor-based program coverage exceeds 30%. The circles illustrate the incremental cost-effectiveness of <i>Counselor</i> strategy to <i>Provider</i> strategy testing at alternative rates of provider-based program coverage; counselor-based coverage is held constant at its base case value (57%).</p

Antiretroviral therapy input parameters for model-based analyses.

<p>*At 24 weeks.</p