Targeted screening for human immunodeficiency virus infection in Spanish emergency departments: an analysis of epidemiologic and economic impact

Objectives: To evaluate the potential epidemiologic and economic impact of applying an HIV screening protocol in hospital emergency departments (ED) and compare it to current clinical practice in Spain. Material and methods: We estimated the cumulative incidence of human immunodeficiency virus (HIV) infections and associated costs in Spain for a 20-year time horizon based on a model comprised of various health states with different risks for HIV transmission. The impact of current clinical practices in Spain, in which there is no established protocol for HIV screening, was compared to the potential impact of applying a targeted screening protocol in persons who come to the ED with certain conditions suggestive of HIV infection (diagnosis of a sexually transmitted infection, mononucleosis, herpes zoster infection, community-acquired pneumonia; practice of chemsex, and need for postexposure prophylaxis). Results: Screening all persons with a condition suggestive of HIV infection in hospital EDs would require an investment of epsilon 20 million over 20 years, but it would prevent 13 615 new infections (reducing the incidence by 20.6%, down from 66 265 to 52 650 cases) in comparison with the current diagnostic approaches. Such a reduction in the incidence of HIV infection would potentially save epsilon 4411 million over 20 years, giving a return of epsilon 224 per euro invested. Conclusion: A protocol for targeted screening of persons in circumstances suggestive of risk for HIV infection in Spain would increase diagnoses, avert new infections, and generate savings in comparison with screening practices currently in effect.