Universal HIV screening of pregnant women in England: cost effectiveness analysis.

Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.

Universal HIV screening of pregnant women in England: cost effectiveness analysis.

BMJ. 1999 Jun 19;318(7199):1656-60. Unique Identifier : AIDSLINE MED/99301832
Postma MJ; Beck EJ; Mandalia S; Sherr L; Walters MD; Houweling H; Jager JC; National Institute of Public Health and the Environment, PO Box; 3720 BA Bilthoven, The Netherlands.

Abstract: OBJECTIVE: To estimate the cost effectiveness of universal, voluntary HIV screening of pregnant women in England. DESIGN: Cost effectiveness analysis. Cost estimates of caring for HIV positive children were based on the stage of HIV infection and calculated using data obtained from a London hospital between 1986 and 1996. These were combined with estimates of the health benefits and costs of antenatal screening so that the cost effectiveness of universal, voluntary antenatal screening for HIV infection in England could be estimated. MAIN OUTCOME MEASURES: Lifetime, direct costs of medical care of childhood HIV infection; life years gained as a result of the screening programme; net cost per life year gained for different pretest counselling costs; and different prevalence rates of pregnant women who were unaware that they were HIV positive. RESULTS: Estimated direct lifetime medical and social care costs of childhood HIV infection were pound178 300 using a 5% discount rate for time preference (1995-6 prices). In high prevalence areas screening pregnant women for HIV is estimated to be a cost effective intervention with a net cost of less than pound4000 for each life year gained. For areas with comparatively low prevalence rates, cost effectiveness could be less than pound20 000 per life year gained, depending on the number of pregnant women who are unaware that they are infected and local screening costs. CONCLUSIONS: Our results confirm recent recommendations that universal, voluntary antenatal HIV screening should be implemented in the London area. Serious consideration of the policy should be given for other areas in England depending on local prevalence and screening costs.

Keywords: JOURNAL ARTICLE Anti-HIV Agents/ECONOMICS/THERAPEUTIC USE AIDS Serodiagnosis/*ECONOMICS Cost of Illness Cost-Benefit Analysis England Female Health Care Costs Human HIV Infections/DRUG THERAPY/ECONOMICS/*PREVENTION & CONTROL Mass Screening/*ECONOMICS/ORGANIZATION & ADMIN Pregnancy Pregnancy Complications, Infectious/DRUG THERAPY/ECONOMICS/ *PREVENTION & CONTROL Sensitivity and Specificity Support, Non-U.S. Gov't Zidovudine/ECONOMICS/THERAPEUTIC USE
991030
A99A0942

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