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Prevention of HIV infection in drug abusers: a cost analysis.

BACKGROUND
Counseling and testing for HIV infection is performed at many sites, including drug treatment centers. The actual cost of providing HIV counseling and testing at drug treatment sites, based upon empirical data collection, has not been reported. The average lifetime medical cost for an HIV-infected individual is $56,000. This study provides both a systematic method for estimating HIV counseling and testing costs and actual cost results. These results can be compared with the medical costs associated with HIV infection.


METHODS
At three publicly funded methadone treatment centers, we collected cost data on the provision of HIV counseling and testing. We obtained provider service times for HIV counseling and testing components, provider salaries and fringe rates, laboratory costs, and support costs at each center.


RESULTS
The average cost of HIV counseling and testing is $215 per client entering HIV counseling and testing and $341 per client made aware of HIV serostatus. The total direct cost of providing HIV counseling and testing is $41 for an HIV-negative client who completes the process and $57 for an HIV-positive client; the support costs add an additional $175 per client.


CONCLUSIONS
Existing methadone maintenance treatment clinics planning to add HIV counseling and testing can expect costs in a range of $189 to $242 per person entering HIV counseling and testing (1991 dollars). Using an average lifetime cost of HIV infection ($56,000) and the average cost per person entering HIV counseling and testing ($215), if more than 1 person in 260 changes his or her behavior to prevent one additional HIV infection, the ratio of medical care savings to costs of counseling and testing would be greater than 1.0, a cost-saving prevention strategy.