AEGiS-13IAC: Would antenatal screening for HIV be cost-effective in a low prevalence setting.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Would antenatal screening for HIV be cost-effective in a low prevalence setting.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. WeOrC617)

Ziegler JB, Fisher RJ, Law M
J.B. Ziegler, Sydney Children's Hospital, High Street, Randwick NSW 2031, Australia, Tel.: +61 029 382 1515, Fax: +61 293 821 580, E-mail: j.ziegler@unsw.edu.au

BACKGROUND: Mother-to-child transmission (MCT) of HIV can be almost completely if mothers' HIV positivity is known pre partum. In Australia antenatal (AN) HIV screening is recommended only for women reporting risk factors for HIV. Nevertheless half the Australian women known to have had a perinatally exposed child were not recognised to be HIV +ve prenatally. Many HIV +ve mothers report no exposure risks and would be have been missed by targeted screening.

METHODS: In Australia (260,000 live births pa) we assumed the prevalence of previously unrecognised HIV to be 1:20,000; a MCT rate of 33% which drops to 2% with antiretroviral (ARV) prophylaxis, caesarean section (CS) and formula feeding (FF); 100% uptake of ARV & FF, 80% uptake of CS. We incorporated known or estimated costs of HIV antibody testing, pre- and post-test counselling, ACTG 076 drug costs, CS, FF, lifetime care of an infected child, and additional costs relating to earlier maternal diagnosis. We assumed each infant infection averted gained 75 life years (LY) but made no assumptions about impact of AN diagnosis on life expectancy of infected women or infants infected despite screening. We assumed 20% of newly diagnosed women would elect termination (thus aborting mainly potentially uninfected babies). We have not allowed for possible impact on MCT of CS for non-HIV indications in unscreened mothers, nor for pregnancies uncompleted after AN screening.

RESULTS: The net cost of such a program in Australia would be $5.5 ó Ç Ö 106 pa. The net cost per LY gained would be $$24,843, comparable to hypertension screening and mammography for women age 50-70 years. The cost per LY gained would be $54,898 if a discount of 2.5% p.a. was applied. AN screening would be cost neutral if the maternal prevalence rate was 1:2,000.

CONCLUSIONS: State and federal health authorities should re-examine their decisions not to recommend that all Australian women receiving AN care be encouraged to undergo HIV screening.

Keywords: AEGIS, Prevalence, HIV Infections, Mass Screening, HIV Seropositivity, Risk Factors, Cost-Benefit Analysis, Counseling, Health Care Costs, Cost of Illness, Australia, Human, Female, Infant, Child, epidemiology, economics
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