The cost-effectiveness of voluntary intrapartum rapid human immunodeficiency virus testing for women without adequate prenatal care.
OBJECTIVE
We sought to determine the health and economic consequences of voluntary rapid human immunodeficiency testing during labor for women who have not received adequate prenatal care.


METHODS
A decision-tree model was used to assess the number of pediatric human immunodeficiency virus cases that would be averted if women who were unable to determine their human immunodeficiency virus serostatus antenatally were offered an intrapartum rapid human immunodeficiency virus test. Medical costs associated with the introduction of this policy were also determined. Probability and cost estimates entered into the model are based on data in the published literature.


RESULTS
Under the base-case assumptions, a policy of intrapartum voluntary rapid human immunodeficiency virus testing decreases the number of cases of perinatal human immunodeficiency virus from 407 to 339 per 100,000 women without adequate prenatal care per year, with a corresponding cost savings of $6 million. Sensitivity analysis demonstrates that these cost savings are maintained across a wide range of assumptions and that even conservative scenarios still result in a cost-effective policy.


CONCLUSIONS
In the absence of adequate prenatal care, a voluntary rapid human immunodeficiency virus test not only allows patients to fully explore their options with regard to testing and treatment but also has the potential to provide significant health benefits to women and children and economic benefits to the medical system.
Grobman
W A
WA
Section of Maternal-Fetal Medicine and the Department of Obstetrics and Gynecology, Northwestern Memorial Hospital, Northwestern University Medical School, Chicago, Illinois, USA.
Garcia
P M
PM
D000704:Analysis of Variance; D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000191:economics / Q000517:prevention & control; D007743:Labor, Obstetric; D008403:Mass Screening / Q000191:economics*; D017059:Models, Econometric; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control; D011295:Prenatal Care; D012680:Sensitivity and Specificity; D013997:Time Factors; D015215:Zidovudine / Q000191:economics / Q000627:therapeutic use
D019380:Anti-HIV Agents; D015215:Zidovudine