Using capacity planning models to estimate organizational costs of HIV care within the United States Department of Veterans Affairs

The Veterans Affairs (VA) health care system is the largest provider of HIV care in the US, providing care for more than 25,000 HIV infected veterans in 2007. HIV testing is a high priority for the VA because VA patients have HIV risk factors. Many veterans at increased risk for HIV are not tested. Thus, many HIV-positive veterans are diagnosed later in the disease, negatively impacting health outcomes as well as increased VA costs related to late treatment entry. This study's objectives were to obtain the sufficient capacity to perform a rigorous evaluation of organizational costs associated with increases in HIV screening rates, based on expertly-chosen criterion. Cost effectiveness findings should be elucidated clearly to non-research facility managers for whom costs associated with proposed changes are paramount. Business case modeling provides us with that link.

A business case justifies an action regarding costs and benefits, typically a prerequisite for goal-setting or a large project. The business case addresses the need that a given project seeks to resolve and includes: project relevance, benefits, costs, and risk. This model estimates the organizational cost of expanding HIV testing in one large, university-affiliated VA facility in Southern California. Models were constructed using MS Excel. Inputs were derived from providers familiar with patient care factors. We estimated first-year costs in specific categories under two scenarios: 1) increasing screening rates from 0-5%, 2) increasing from 0-10%. Endpoints included antiretroviral and drug costs, patient flow estimates, testing/treating HIV patients, changes in staff, pharmacy and lab costs.

Analysis showed that organizational costs of $425,027 (including costs related to lab, personnel, and pharmacy) in the first quarter could be sufficient at a HIV testing rate of 3%, and more than doubling HIV testing to 10% has an additional cost impact of $82,646 on quarterly organizational costs. Our model provided an anticipated cost estimate for facilities considering increasing HIV testing.

Because the VA population traditionally has higher HIV prevalence than the general population, broad-based HIV screening could be cost-effective. However, though the costs of implementing an expanded HIV testing program are immediate, the long-term benefits and costs derived from decreased disease progression were previously unknown. The effectiveness of cost modeling has important implications for organizational impacts associated with changes in care delivery. Stakeholders and facility/organizational managers should consider the use of capacity planning models of this sort to extrapolate future costs based on current actions.