THE COST-EFFECTIVENESS OF HUMAN-IMMUNODEFICIENCY-VIRUS SCREENING IN PREGNANCY

OBJECTIVE: My purpose was to evaluate the cost-effectiveness of screen ing for human immunodeficiency virus during pregnancy as part of a pro tocol in which zidovudine was used to reduce the risk of vertical tran smission. STUDY DESIGN: This mathematic model used decision analysis t o calculate the marginal cost-effectiveness of screening for human imm unodeficiency virus in pregnancy and treating human immunodeficiency v irus-positive women with zidovudine. Cost and probability assumptions were drawn from a literature review. Sensitivity analyses were perform ed for important costs and probabilities. RESULTS: When baseline cost and probability assumptions were used, the marginal cost-effectiveness of human immunodeficiency virus screening was $436,927 when the preva lence of human immunodeficiency virus in the population was low (0.000 75) and $198,510 when the prevalence was average (0.0015). Above a pre valence of human immunodeficiency virus of 0.009, testing is both chea per and more effective than not testing. Of the cost variables examine d, the charge for a negative testing sequence had the greatest impact on cost-effectiveness. CONCLUSION: Human immunodeficiency virus testin g in pregnancy is cost-effective in populations in which the prevalenc e of human immunodeficiency virus exceeds 9 per 1000 population. Depen ding on how individual lives saved are valued, screening may also be w arranted in populations with lower prevalences of infection.