Presentation Preoperative HIV testing: Is it less expensive than universal precautions?

Valerie A. Lawrence, Amiram Gafni, Kurt Kroenke

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Universal precautions are officially recommended to prevent HIV transmission in health care settings but for elective surgery some advocate routine preoperative HIV testing. These strategies have not been tested in clinical trials but universal precautions are very expensive and not cost-effective. Thus, for elective surgery, routine testing might save resources by permitting selective use of additional barrier precautions. We performed an economic evaluation to compare both strategies, using a simple approach to determine if routine testing (RT) is less expensive than universal precautions (UP). Conservatively assuming equal effectiveness in preventing HIV transmission, we compared a minimized estimate for the average cost of RT with a maximized estimate for the average cost of UP per elective operation. The minimized estimate for RT (US$57) was greater than the maximized estimate for UP (US$36) per procedure. Results were stable or strengthened by sensitivity analysis. Routine HIV testing is not a valid economic alternative to UP for elective surgery. The simple methodology used in this study can be a preliminary strategy to review other strategies for preventing HIV transmission. This method is particularly useful when data are inadequate for a formal economic evaluation to determine the utility of collecting the detailed information necessary for a full comparison.

Original languageEnglish (US)
Pages (from-to)1219-1227
Number of pages9
JournalJournal of Clinical Epidemiology
Issue number11
StatePublished - Nov 1993


  • HIV infection
  • Medical economics
  • Occupational diseases
  • Preoperative care
  • Risk factors
  • Surgical (operative)
  • control
  • prevention
  • transmission

ASJC Scopus subject areas

  • Epidemiology

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