Emergency Department Management of Occupational Exposures: Cost Analysis of Rapid HIV Test [Kallenborn JC et al. Infect Control Hosp Epidemiol 2001; 22: 289]: The authors investigated the cost impact of using a rapid HIV detection method (SUDS) in evaluating patients with occupational exposures to HIV. During the 13-month review, there were17 exposures that constituted potential risks by the CDC for HIV transmission. All 17 proved negative by SUDS testing. The authors then estimated the cost for prophylaxis using the conventional EIA test with antiretroviral agents for the period before EIA test results were known. The total cost with the rapid test was $465, which is the cost of laboratory testing; by contrast, the cost for EIA testing was $5,965. The authors conclude that rapid tests are associated with substantial cost savings.
Comment: The rapid test is associated with substantial cost savings, but also a great deal of unnecessary morbidity in health care workers who have potential exposures to HIV from patients with unknown serologic status. It is easy to endorse this policy and surprising that more hospitals have not done so. One impediment at the present time is the fact that SUDS has not been available since November 11, 2000 due to manufacturing problems. There are several other alternative rapid tests that are currently under review at the FDA. These will have the benefit of interpretation by providers so that a laboratory technician is not necessary, the cost will probably be substantially less, and the accuracy appears to match that of standard serology. Until these tests are available, most of us will be stuck with the techniques used in the economically inefficient control group in this analysis.
posted 7/3/2001

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