ECONOMIC-IMPACT OF TREATMENT OF HIV-POSITIVE PREGNANT-WOMEN AND THEIRNEWBORNS WITH ZIDOVUDINE - IMPLICATIONS FOR HIV SCREENING

Objectives.-To estimate the economic impact of (1) treating pregnant w omen who are human immunodeficiency virus (HIV)-positive with zidovudi ne and (2) voluntary screening programs for pregnant women for HIV inf ection and offering treatment with zidovudine to those found to be HIV -positive. Main Outcome Measures.-Number of cases of pediatric HIV inf ection and costs of screening, zidovudine treatment, and pediatric HIV infection treatment. Design.-Health care costs associated with treatm ent of HIV-positive pregnant women and their newborns are estimated as the costs of zidovudine and its administration and the reduction in c osts of treating pediatric HIV infection. The lifetime costs of pediat ric HIV infection are derived from the published literature. Estimates of the reduction in maternal-to-fetal transmission rates are taken fr om the AIDS [acquired immunodeficiency syndrome] Clinical Trials Group (ACTG) Protocol 076, Costs of a voluntary screening program include c osts of screening tests and counseling. Sensitivity and threshold anal yses are performed to determine the impact of changes in input paramet er values including zidovudine treatment costs, efficacy of treatment, costs of pediatric HIV infection, prevalence of HIV infection in preg nant women, screening test sensitivity and specificity, and pregnancy termination rates on the results. Results.-Assuming transmission rates are reduced from 25.5% to 8.3% as found in the ACTG 076 trial, treatm ent costs of $104 502 for 100 HIV-positive pregnant women and their ne wborns are offset by the reduction of $1 701 333 associated with fewer cases of pediatric HIV infection for a net savings of $1 596 831. The sensitivity and threshold analyses show that overall cost savings fro m treatment of HIV-positive pregnant women and their newborns are achi eved for a wide range of possible maternal treatment costs, efficacy r ates, and lifetime pediatric HIV treatment costs. In the base-case ana lysis for the voluntary screening program, overall cost savings are se en when the HIV prevalence rate among pregnant women is greater than 4 .6 per 1000. However, this threshold prevalence rate is sensitive to c hanges in parameter values-especially pediatric HIV treatment costs, c ounseling costs, efficacy of treatment, and years of additional HIV tr eatment for the pregnant women. Conclusions.-Offering zidovudine treat ment to pregnant women known to be HIV-positive will decrease the numb er of cases of pediatric HIV infection and reduce health care costs. V oluntary screening programs for pregnant women will further decrease t he number of cases of pediatric HIV infection. The effect of a screeni ng program on health care costs varies according to HIV prevalence and the costs associated with the screening program.