Abstract:
BACKGROUND:Although HIV infection is more prevalent in people younger than age 45 years, a substantial number of infections occur in older persons. Recent guidelines recommend HIV screening in patients age 13 to 64 years. The cost-effectiveness of HIV screening in patients age 55 to 75 years is uncertain. OBJECTIVE:To examine the costs and benefits of HIV screening in patients age 55 to 75 years. DESIGN:Markov model. DATA SOURCES:Derived from the literature. TARGET POPULATION:Patients age 55 to 75 years with unknown HIV status. TIME HORIZON:Lifetime. PERSPECTIVE:Societal. INTERVENTION:HIV screening program for patients age 55 to 75 years compared with current practice. OUTCOME MEASURES:Life-years, quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS:For a 65-year-old patient, HIV screening using traditional counseling costs $55,440 per QALY compared with current practice when the prevalence of HIV was 0.5% and the patient did not have a sexual partner at risk. In sexually active patients, the incremental cost-effectiveness ratio was $30,020 per QALY. At a prevalence of 0.1%, HIV screening cost less than $60,000 per QALY for patients younger than age 75 years with a partner at risk if less costly streamlined counseling is used. RESULTS OF SENSITIVITY ANALYSIS:Cost-effectiveness of HIV screening depended on HIV prevalence, age of the patient, counseling costs, and whether the patient was sexually active. Sensitivity analyses with other variables did not change the results substantially. LIMITATIONS:The effects of age on the toxicity and efficacy of highly active antiretroviral therapy and death from AIDS were uncertain. Sensitivity analyses exploring these variables did not qualitatively affect the results. CONCLUSION:If the tested population has an HIV prevalence of 0.1% or greater, HIV screening in persons from age 55 to 75 years reaches conventional levels of cost-effectiveness when counseling is streamlined and if the screened patient has a partner at risk. Screening patients with advanced age for HIV is economically attractive in many circumstances.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Sanders GD,Bayoumi AM,Holodniy M,Owens DKdoi
10.7326/0003-4819-148-12-200806170-00002subject
Has Abstractpub_date
2008-06-17 00:00:00pages
889-903issue
12eissn
0003-4819issn
1539-3704pii
148/12/889journal_volume
148pub_type
杂志文章abstract::Transmission of the human immunodeficiency virus (HIV) was studied in a group of patients with cancer who received transfusion of blood components harvested from a single, asymptomatic, seropositive donor. Of ten living recipients, nine had antibodies to the virus in fresh or cryopreserved sera at a median of 384 days...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-105-4-519
更新日期:1986-10-01 00:00:00
abstract::In 1993, the Clinical Efficacy Assessment Subcommittee began evaluation of new topics and reevaluation of previous guidelines on common screening tests, which were published in Annals of Internal Medicine between 1988 and 1990 and republished as a collection in 1991 (Eddy DM, ed. Common Screening Tests. Philadelphia: ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-122-12-199506150-00008
更新日期:1995-06-15 00:00:00
abstract::Recently developed radioligand binding techniques permit direct investigation of the alpha- and beta-adrenergic receptors for catecholamines in a wide variety of tissues. These techniques allow the receptors to be quantitated, characterized, and studied under varying conditions of physiologic and pathophysiologic inte...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-91-3-450
更新日期:1979-09-01 00:00:00
abstract:BACKGROUND:U.S. HIV treatment guidelines recommend branded once-daily, 1-pill efavirenz-emtricitabine-tenofovir as first-line antiretroviral therapy (ART). With the anticipated approval of generic efavirenz in the United States, a once-daily, 3-pill alternative (generic efavirenz, generic lamivudine, and tenofovir) wil...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-158-2-201301150-00002
更新日期:2013-01-15 00:00:00
abstract::This guideline summarizes the current approaches for the diagnosis of venous thromboembolism. The importance of early diagnosis to prevent mortality and morbidity associated with venous thromboembolism cannot be overstressed. This field is highly dynamic, however, and new evidence is emerging periodically that may cha...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-146-6-200703200-00013
更新日期:2007-03-20 00:00:00
abstract::The competition for funds to conduct clinical research is intense, and only a minority of grant proposals receive funding. In particular, funding for patient-oriented research lags behind that allocated for basic science research. Grant writing is a skill of fundamental importance to the clinical researcher, and condu...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-142-4-200502150-00009
更新日期:2005-02-15 00:00:00
abstract:BACKGROUND:Some health plans profile physicians on the basis of their relative costs and use these profiles to assign physicians to cost categories. Physician organizations have questioned whether the rules used to attribute costs to a physician affect the cost category to which that physician is assigned. OBJECTIVE:T...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-152-10-201005180-00005
更新日期:2010-05-18 00:00:00
abstract:OBJECTIVE:To examine, from the perspective of primary care physicians, the value of mental status findings and ancillary tests in diagnosing dementia or its causes. DATA SOURCES:Studies identified using MEDLINE and bibliographies of pertinent articles. STUDY SELECTION:Selection based on availability of information on...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-115-2-122
更新日期:1991-07-15 00:00:00
abstract::We studied D-penicillamine toxicity in 259 patients with systemic sclerosis treated since 1972. The average daily dose of 635 mg was given for a mean of 1.8 years. Of patients with systemic sclerosis, 47% has side effects from D-penicillamine treatment, similar to the 56% of 807 patients with rheumatoid arthritis in s...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-104-5-699
更新日期:1986-05-01 00:00:00
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更新日期:2021-01-19 00:00:00
abstract:OBJECTIVE:To evaluate the risk for chronic renal disease associated with regular use of nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs). DESIGN:Multicenter case-control study. PATIENTS:Patients were 554 North Carolina residents (age range, 30 to 79 years) hospitalized between 1980 and 1982 with a discharge d...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-115-3-165
更新日期:1991-08-01 00:00:00
abstract::Three cases of carbamazepine-induced granulomatous hepatitis are reported. Each patient had ingested carbamazepine for less than 1 month before presenting with a febrile illness suggestive of biliary tract infection. After withdrawal of carbamazepine, symptoms disappeared rapidly. Histologically, all patients had gran...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-95-1-64
更新日期:1981-07-01 00:00:00
abstract::Reversible cerebral vasoconstriction syndromes (RCVS) comprise a group of diverse conditions, all characterized by reversible multifocal narrowing of the cerebral arteries heralded by sudden (thunderclap), severe headaches with or without associated neurologic deficits. Reversible cerebral vasoconstriction syndromes a...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-146-1-200701020-00007
更新日期:2007-01-02 00:00:00
abstract:OBJECTIVE:To determine the necessity of posteroanterior chest roentgenography for the identification of pneumothorax and other complications after thoracentesis. DESIGN:Prospective cohort study. SETTING:Tertiary care teaching hospital. PATIENTS:67 men and 43 women (mean age +/- SD, 62.4 +/- 13.2 years). Exclusion cr...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-124-9-199605010-00005
更新日期:1996-05-01 00:00:00
abstract:BACKGROUND:Use of proton-pump inhibitors in the management of peptic ulcer bleeding is controversial because discrepant results have been reported in different ethnic groups. OBJECTIVE:To determine whether intravenous esomeprazole prevents recurrent peptic ulcer bleeding better than placebo in a multiethnic patient sa...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-150-7-200904070-00105
更新日期:2009-04-07 00:00:00
abstract::Ten patients with lupus nephritis and marked proteinuria (3.9 g or more/d) that did not respond adequately to treatment with prednisone alone or prednisone in combination with azathioprine were treated with total lymphoid irradiation in an uncontrolled feasibility study. Within 6 weeks after the start of total lymphoi...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-102-4-450
更新日期:1985-04-01 00:00:00
abstract:BACKGROUND:Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) are anti-inflammatory but have been linked in some studies to Crohn disease (CD) and ulcerative colitis (UC). OBJECTIVE:To assess the association between aspirin and NSAID use and incident CD and UC. DESIGN:Prospective cohort study. SETTING:Nurses'...
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pub_type: 杂志文章
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更新日期:2012-03-06 00:00:00
abstract::Common variable immunodeficiency (CVI) is a heterogenous immunodeficiency syndrome characterized by hypogammaglobulinemia, recurrent bacterial infections, and various immunologic abnormalities. In addition to recurrent infections, patients with this syndrome also have an increased incidence of autoimmune disease and m...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-118-9-199305010-00011
更新日期:1993-05-01 00:00:00
abstract:BACKGROUND:In AIDS, nodular skin disease can result from various causes. OBJECTIVE:To report a new manifestation of microsporidial infection presenting as nodular skin disease with underlying osteomyelitis. DESIGN:Case report. SETTING:Tertiary-care military medical center in Washington, D.C. PATIENT:A 36-year-old w...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-128-11-199806010-00009
更新日期:1998-06-01 00:00:00
abstract:Description:The Kidney Disease: Improving Global Outcomes (KDIGO) 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD) is a selective update of the prior CKD-MBD guideline published in 2009. The guideline update an...
journal_title:Annals of internal medicine
pub_type: 杂志文章,实务指引
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更新日期:2018-03-20 00:00:00
abstract:BACKGROUND:Although some studies suggest that access to cardiac procedures may differ by sex, others have found no evidence of gender bias in cardiac care. OBJECTIVE:To study rates of percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery in men and women after cardiac catheterization....
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-136-10-200205210-00007
更新日期:2002-05-21 00:00:00
abstract::The observations that have provided the foundation of the sodium hypothesis of human hypertension are reviewed. Clinical observations made over 125 years ago initiated an investigative effort that has encompassed epidemiologic data, development of salt-related experimental models, and elucidation of theoretical mechan...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-98-5-720
更新日期:1983-05-01 00:00:00
abstract:OBJECTIVE:To reassess the natural history of polycythemia vera and to obtain reliable estimates of both incidence of thrombosis and survival for use in defining the sample size for therapeutic clinical trials. STUDY DESIGN:Retrospective cohort study of patients with polycythemia who had been followed for 20 years. SE...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-123-9-199511010-00003
更新日期:1995-11-01 00:00:00
abstract::To characterize the role of cardiac function in septic shock, serial radionuclide cineangiographic and hemodynamic evaluations were done on 20 patients with documented septic shock. Although all patients had a normal or elevated cardiac index, 10 patients had moderate to severe depression of their ejection fraction wi...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-100-4-483
更新日期:1984-04-01 00:00:00
abstract:OBJECTIVE:To determine which procedures nephrologists do in practice, where they learned the procedures, and how much training they recommend to achieve and maintain clinical competence in each. DESIGN:Mailed survey. PARTICIPANTS:A random sample of 700 members of the American College of Physicians who were identified...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-113-5-392
更新日期:1990-09-01 00:00:00
abstract::Clinical features of 99 patients with staphylococcal infection were reviewed, and sera were tested by solid-phase radioimmunoassay and gel diffusion for staphylococcal antibodies to ascertain whether these variables predict the extent of infection and the need for prolonged therapy. Clinical features, including the pr...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-89-4-467
更新日期:1978-10-01 00:00:00
abstract:OBJECTIVE:To determine the frequency of tests done in the year before elective surgery that might substitute for preoperative screening tests and to determine the frequency of test results that change from a normal value to a value likely to alter perioperative management. DESIGN:Retrospective cohort analysis of compu...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-113-12-969
更新日期:1990-12-15 00:00:00
abstract::A retrospective analysis of the course of systemic lupus erythematosus in pregnant patients hospitalized at UCLA during a 15-year period provided important prognostic information. Women with systemic lupus erythematosus became pregnant if renal function was reasonably well preserved. Pregnancy infrequently posed a ser...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-94-5-667
更新日期:1981-05-01 00:00:00
abstract::The syndrome of bulimia is a common disorder and can be associated with serious psychological and physical morbidity. Unfortunately, many patients are reluctant to discuss their symptoms with their physicians and few clues can be found on physical examination to aid in the diagnosis. Possible physical signs include ul...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-107-1-71
更新日期:1987-07-01 00:00:00
abstract:DESCRIPTION:The American College of Physicians (ACP) developed this guideline to present the available evidence on various pharmacologic treatments to prevent fractures in men and women with low bone density or osteoporosis. METHODS:Published literature on this topic was identified by using MEDLINE (1966 to December 2...
journal_title:Annals of internal medicine
pub_type: 杂志文章,实务指引
doi:
更新日期:2008-09-16 00:00:00