Cost-effectiveness of cesarean section delivery to prevent mother-to-child transmission of HIV-1.
OBJECTIVE
To evaluate costs and outcomes of cesarean section performed before onset of labor and before rupture of membranes (elective cesarean section) compared to vaginal delivery among HIV-infected women.


METHODS
Cost-effectiveness and cost-benefit analysis.


METHODS
Pregnant HIV-infected women in the US who refrain from breastfeeding.


METHODS
Elective cesarean section versus vaginal delivery by antiretroviral therapy regimen.


METHODS
Pediatric HIV cases avoided, years of life saved, and direct medical costs for maternal interventions and pediatric HIV treatment.


RESULTS
Elective cesarean section (versus vaginal delivery) was cost-effective among women receiving zidovudine prophylaxis (US$1131 per case avoided, US$17 per year of life saved) and combination antiretroviral therapy (US$112693 per case avoided, US$1697 per year of life saved), and cost saving among women receiving no antiretroviral therapy during pregnancy (benefit-cost ratio of 2.23). Although elective cesarean section remained cost-effective, results were sensitive to variations in vertical transmission rates and to pediatric HIV treatment costs. Population-based analyses indicated that elective cesarean section could prevent 239 pediatric HIV cases annually with a savings of over US$4 million.


CONCLUSIONS
Elective cesarean section is a cost-effective intervention to prevent vertical transmission of HIV among women receiving various antiretroviral therapy regimens, who refrain from breastfeeding.
Halpern
M T
MT
MEDTAP International, Inc., Rockville, Maryland, USA.
Read
J S
JS
Ganoczy
D A
DA
Harris
D R
DR
D019380:Anti-HIV Agents / Q000627:therapeutic use; D002585:Cesarean Section / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D036861:Delivery, Obstetric; D017558:Elective Surgical Procedures; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control / Q000635:transmission*; D015497:HIV-1 / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D018803:Models, Economic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000821:virology*; D015215:Zidovudine / Q000627:therapeutic use
D019380:Anti-HIV Agents; D015215:Zidovudine