[A comparison of three screening strategies for prevention of perinatal HIV infection in Colombia: a decision analysis model].
OBJECTIVE
To apply decision analysis to compare the cost-effectiveness of three strategies for HIV screening of pregnant women and to recommend the one most appropriate for the health care system of Colombia.


METHODS
An economic study applying decision analysis to three types of HIV screening of expectant women: voluntary, universal, and optional. All the women in Colombia with unknown HIV status who were admitted for child birth were included. The study included all the direct medical costs incurred from the time of testing through the first year following delivery, according to the General System for Healthcare Social Security. Cost-effectiveness ratio and the savings of each of the strategies were compared.


RESULTS
For every 10,000 women, the universal strategy detected five cases more than the voluntary strategy and seven cases more than the optional. The universal strategy carried a cost of approximately US$ 17 for each HIV-positive newborn; that is, less than half of that of the voluntary strategy (US$ 38) and less than the optional (US$ 24). According to the bifactorial analysis, the universal screening strategy was less costly than the voluntary and more effective than both of the others, regardless of prevalence, the false-positive rate of each method, and the rate of maternal compliance with screening.


CONCLUSIONS
The screening strategy currently in use in Colombia is more costly (in both the medium- and long-term), less effective, and less capable of prevention, than the universal screening strategy. The recommendation to the national health authorities of Colombia is to begin screening all pregnant women for HIV infection using third-generation testing.
Gómez
Marcela
M
Fundación Universitaria de Ciencias de la Salud, División de Investigaciones, Santa Fe de Bogotá, Colombia. m2gomez@gmail.com
D015492:AIDS Serodiagnosis / Q000191:economics / Q000379:methods*; D000328:Adult; D015153:Blotting, Western / Q000191:economics; D003105:Colombia / Q000453:epidemiology; D003365:Costs and Cost Analysis; D003663:Decision Trees; D004797:Enzyme-Linked Immunosorbent Assay / Q000191:economics; D005189:False Positive Reactions; D005260:Female; D015658:HIV Infections / Q000151:congenital / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000191:economics / Q000517:prevention & control*; D008297:Male; D018580:Mandatory Testing / Q000191:economics; D008403:Mass Screening / Q000191:economics / Q000379:methods*; D010342:Patient Acceptance of Health Care; D016133:Polymerase Chain Reaction / Q000191:economics; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D011295:Prenatal Care / Q000191:economics / Q000379:methods*; D035141:Voluntary Programs / Q000191:economics