In Germany, an estimated 8,200 individuals were living with undiagnosed HIV in 2023. Late diagnosis (CD4<350) was 52% and 33% of individuals with HIV are diagnosed with advanced disease (1) .
Despite progress toward the WHO viral hepatitis elimination goals, a large proportion of infections remain undiagnosed: 85% for hepatitis B (HBV) and 60% for hepatitis C (HCV) (2). These figures indicate that current blood-borne virus (BBV; HIV, HBV, HCV) testing strategies are insufficient to meet elimination targets and to reduce BBVs as public health threats.
Recent European studies demonstrate effectiveness and suggest cost-effectiveness of BBV opt-out (OOT) emergency department (ED) testing in high-prevalence areas (3–7). Currently in Germany, however, there is no systematic BBV screening in routine healthcare settings.
In a recent study, we developed a hybrid health economic model to simulate both short-term (new diagnoses and patients’ linkage to care (LTC)) and long-term (cost-effectiveness) impacts of ED BBV OOT compared with current testing practices in ED (standard of care; SoC). The analysis was conducted from a National Health Service perspective over a lifetime horizon. Primary outcomes included the number of new diagnoses, individuals linked to care, quality-adjusted life years (QALYs), and costs (discounted at 1.5% and 3% per annum).
Model results indicate that, for every 10,000 people having ED blood tests, BBV OOT resulted in 82 additional new BBV diagnoses and 39 more individuals LTC compared with SoC. The strategy proved highly cost-effective at the willingness-to-pay threshold of €42,634 (8), with a weighted average of €5,762 per quality-adjusted life year (QALY) gained at a combined BBV prevalence of 1.5% (6,9,10). As the model did not account for transmission averted or broader societal benefits, these results may underestimate the true benefits and economic gains.
Our findings suggest that ED-based combined BBV OOT in high-prevalence areas in Germany could offer greater health benefits and substantially improve value for money than HIV testing alone. We encourage further national dialogue on innovative testing strategies to reduce late diagnosis and real-world studies to validate these findings.
The findings of this research were presented at the European AIDS Clinical Society (EACS) in Paris in October 2025.email us at info@aquariusph.com.
Citation: Rockstroh JK, Stocker H, et al. Estimating the health impact and cost-effectiveness of emergency department opt-out testing for blood-borne viruses in Germany. Poster presented at EACS Conference; 15-18th October 2025, Paris, France. EACS Abstract 2025 – 2025 – HIV Medicine – Wiley Online Library
Link to EACS poster
To learn more about our work at Aquarius, please visit our website or email us at info@aquariusph.com
References
- HIV/AIDS Surveillance in Europe 2024 – 2023 data [Internet]. 2024 [cited 2025 Aug 12]. Available from: https://www.ecdc.europa.eu/en/publications-data/hiv-aids-surveillance-europe-2024-2023-data
- Wolffram I, Petroff D, Bätz O, Jedrysiak K, Kramer J, Tenckhoff H, et al. Prevalence of elevated ALT values, HBsAg, and anti-HCV in the primary care setting and evaluation of guideline defined hepatitis risk scenarios. J Hepatol. 2015 June 1;62(6):1256–64.
- Townsend L, Herraghty F, Brennan S, Grant C, Wang W, Moriarty A, et al. Outcomes 10 Years After Implementing an Emergency Department Opt-out Bloodborne Virus Screening Program. Open Forum Infect Dis [Internet]. 2025 Aug 29 [cited 2025 Oct 17];12(9). Available from: https://dx.doi.org/10.1093/ofid/ofaf547
- Smout E, Ruf M, Buti M, Pinto IV, Nebbia G, Hunter L, et al. Blood-borne virus testing in European emergency departments: current evidence and service considerations. Eur J Public Health. 2025 Aug 1;35(4):766–73.
- GOV.UK [Internet]. [cited 2025 Aug 12]. Public health evaluation of BBV opt-out testing in EDs in England: 24-month interim report. Available from: https://www.gov.uk/government/publications/bloodborne-viruses-opt-out-testing-in-emergency-departments/public-health-evaluation-of-bbv-opt-out-testing-in-eds-in-england-24-month-interim-report
- Williams J, Vickerman P, Douthwaite S, Nebbia G, Hunter L, Wong T, et al. An Economic Evaluation of the Cost-Effectiveness of Opt-Out Hepatitis B and Hepatitis C Testing in an Emergency Department Setting in the United Kingdom. Value Health. 2020 Aug 1;23(8):1003–11.
- d’Arminio Monforte A, d’Ettorre G, Galardo G, Lani E, Kagenaar E, Huntington S, et al. Estimating the potential health economic value of introducing universal opt-out testing for HIV in emergency departments in Italy. Eur J Public Health [Internet]. [cited 2025 Aug 12]; Available from: https://dx.doi.org/10.1093/eurpub/ckaf057
- Gandjour A. A Model-Based Estimate of the Cost-Effectiveness Threshold in Germany. Appl Health Econ Health Policy. 2023 July 1;21(4):627–35.
- Akmatov MK, Hu E, Rüsenberg R, Kollan C, Schmidt D, Kohring C, et al. Areas with high HIV prevalence: A spatial analysis of nationwide claims data in Germany. HIV Med. 2024;25(4):498–503.
- Darstein F. Prävalenz und Risikofaktoren von Hepatitis B und C bei Patienten einer Berliner Rettungsstelle: eine analytische Querschnittstudie. 2015 [cited 2025 Aug 13]; Available from: https://refubium.fu-berlin.de/handle/fub188/4896