title: Economic impact of routine opt-out antenatal human immune deficiency virus screening: A systematic review.
abstract: OBJECTIVE
  To evaluate the economic impact of routine testing of human immune deficiency virus in antenatal settings.
  
  
  BACKGROUND
  Many children are being infected with human immune deficiency virus through mother-to-child transmission of the virus. Most of these infections are preventable if the mothers' human immune deficiency virus status is identified in a timely manner and appropriate interventions put in place. Routine human immune deficiency virus testing is widely acclaimed as a strategy for universal access to human immune deficiency virus testing and is being adopted by developed and developing poor income countries without recourse to the economic impact.
  
  
  METHODS
  A systematic review of published articles.
  
  
  METHODS
  Extensive electronic searches for relevant journal articles published from 1998-2015 when countries began to implement routine antenatal HIV testing on their own were conducted in the following databases: Science Direct, MEDLINE, SCOPUS, JSTOR, CINAHL and PubMed with search terms as listed in Box 2. Manual searches were also performed to complement the electronic identification of high-quality materials. There were no geographical restrictions, but language was limited to English.
  
  
  RESULTS
  Fifty-five articles were retrieved; however, ten were eligible and included in the review. The findings showed that many programmes involving routine human immune deficiency virus testing for pregnant women compared to the alternatives were cost-effective and cost saving. Data from the reviewed studies showed cost savings between $5,761.20-$3.69 million per case of previously undiagnosed maternal human immune deficiency virus-positive infection prevented. Overall, cost-effectiveness was strongly associated with the prevalence rate of human immune deficiency virus in the various settings.
  
  
  CONCLUSIONS
  Routine human immune deficiency virus testing is both cost-effective and cost saving compared to the alternatives. However, there are wide variations in the methodological approaches to the studies. Adopting standard reporting format would facilitate comparison between studies and generalisability of economic evaluations.
  
  
  CONCLUSIONS
  (i) Healthcare decision-makers should understand that routine antenatal screening for human immune deficiency virus is both cost-effective and cost saving. (ii) Addressing late identification of prenatal human immune deficiency virus is crucial to reducing mother-to-child transmission at minimal healthcare spending.
authors.affiliation: Nursing Department, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK.
authors.forename: Everistus
authors.identifier: http://orcid.org/0000-0002-0332-0726
authors.initials: E
authors.lastname: Ibekwe
authors.affiliation: Nursing Department, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK.
authors.forename: Carol
authors.initials: C
authors.lastname: Haigh
authors.affiliation: Department of Research Institute for Health & Social Change, Faculty of Health, Rehabilitation and Psychology, Manchester Metropolitan University, Manchester, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Duncan
authors.affiliation: Department of Health Professions, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK.
authors.forename: Francis
authors.initials: F
authors.lastname: Fatoye
mesh_terms: D000328:Adult; D002648:Child; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008403:Mass Screening / Q000191:economics* / Q000706:statistics & numerical data; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000191:economics* / Q000706:statistics & numerical data
keywords: antenatal; cost-effectiveness; counselling and testing; human immune deficiency virus infection; prevention of mother-to-child transmission; routine testing