Cost-Effectiveness of Voluntary HIV Testing Strategies in a Very Low-Prevalence Country, the Republic of Korea

J Korean Med Sci. 2018 Oct 18;33(46):e304. doi: 10.3346/jkms.2018.33.e304. eCollection 2018 Nov 12.


Background: The Republic of Korea has a very low prevalence of human immunodeficiency virus (HIV) infection, but the number of new HIV diagnoses has steadily risen, strongly indicating a large number of undetected HIV infections. Thus, it is important for Korean public health authorities to adopt and encourage cost-effective HIV detection tools, such as rapid HIV screening tests. In this study, we aimed to evaluate the cost-effectiveness of enzyme-linked immunosorbent assays (ELISA) and rapid tests in a public health center (PHC) setting.

Methods: We developed a decision analytic model to assess the per-examinee cost and the cost-effectiveness of identifying HIV patients in a PHC setting using two HIV testing strategies: conventional HIV screening by ELISA versus rapid HIV testing. Analysis was performed in two scenarios: HIV testing in an average-risk population and in a high-risk population.

Results: Compared to the ELISA, the rapid test was cost-saving and cost-effective. The per-examinee cost was USD 1.61 with rapid testing versus USD 3.38 with ELISA in an average-risk population, and USD 4.77 with rapid testing versus USD 7.62 with ELISA in a high-risk population. The cost of identifying a previously undiagnosed HIV case was USD 26,974 with rapid testing versus USD 42,237 with ELISA in an average-risk population, and USD 153 with rapid testing versus USD 183 with ELISA in a high-risk population.

Conclusion: Rapid testing would be more cost-effective than using conventional ELISA testing for identifying previously undiagnosed HIV-infected cases in Korea, a country with extremely low HIV prevalence.

Keywords: Cost-effectiveness Analysis; HIV Screening Test; Korea.

MeSH terms

  • AIDS Serodiagnosis / economics
  • Cost-Benefit Analysis
  • Decision Making
  • Enzyme-Linked Immunosorbent Assay / economics
  • HIV Infections / economics*
  • HIV Infections / epidemiology
  • Humans
  • Mass Screening / economics*
  • Prevalence
  • Public Health
  • Reagent Kits, Diagnostic / economics
  • Republic of Korea
  • Risk
  • Serologic Tests


  • Reagent Kits, Diagnostic