The cost-effectiveness of human immunodeficiency virus screening in pregnancy.
OBJECTIVE
My purpose was to evaluate the cost-effectiveness of screening for human immunodeficiency virus during pregnancy as part of a protocol in which zidovudine was used to reduce the risk of vertical transmission.


METHODS
This mathematic model used decision analysis to calculate the marginal cost-effectiveness of screening for human immunodeficiency virus in pregnancy and treating human immunodeficiency virus-positive women with zidovudine. Cost and probability assumptions were drawn from a literature review. Sensitivity analyses were performed for important costs and probabilities.


RESULTS
When baseline cost and probability assumptions were used, the marginal cost-effectiveness of human immunodeficiency virus screening was $436,927 when the prevalence of human immunodeficiency virus in the population was low (0.00075) and $198,510 when the prevalence was average (0.0015). Above a prevalence of human immunodeficiency virus of 0.009, testing is both cheaper and more effective than not testing. Of the cost variables examined, the charge for a negative testing sequence had the greatest impact on cost-effectiveness.


CONCLUSIONS
Human immunodeficiency virus testing in pregnancy is cost-effective in populations in which the prevalence of human immunodeficiency virus exceeds 9 per 1000 population. Depending on how individual lives saved are valued, screening may also be warranted in populations with lower prevalences of infection.
Ecker
J L
JL
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA.
D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006679:HIV Seropositivity / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D008403:Mass Screening / Q000191:economics*; D015233:Models, Statistical; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control*; D015215:Zidovudine / Q000191:economics / Q000627:therapeutic use
D015215:Zidovudine