PREVENTING PERINATAL TRANSMISSION OF HIV - COSTS AND EFFECTIVENESS OFA RECOMMENDED INTERVENTION

Objective. To calculate the national costs of reducing perinatal trans mission of human immunodeficiency virus through counseling and volunta ry testing of pregnant women and zidovudine treatment of infected wome n and their infants, as recommended by the Public Health Service, and to compare these costs with the savings from reducing the number of pe diatric infections. Method. The authors analyzed the estimated costs o f the intervention and the estimated cost savings from reducing the nu mber of pediatric infections. The outcome measures are the number of i nfections prevented by the intervention and the net cost (cost of inte rvention minus the savings from a reduced number of pediatric HIV infe ctions). The base model assumed that intervention participation and ou tcomes would resemble those found in the AIDS Clinical Trials Group Pr otocol 076. Assumptions were varied regarding maternal seroprevalence, participation by HIV-infected women, the proportion of infected women who accepted and completed the treatment, and the efficacy of zidovud ine to illustrate the effect of these assumptions on infections preven ted and net cost. Results. Without the intervention, a perinatal HIV t ransmission rate of 25% would result in 1750 HIV-infected infants born annually in the United States, with lifetime medical-care costs estim ated at $282 million. The cost of the intervention (counseling, testin g, and zidovudine treatment) was estimated to be $67.6 million. In the base model, the intervention would prevent 656 pediatric HIV infectio ns with a medical care cost saving of $105.6 million. The net cost sav ing of the intervention was $38.1 million. Conclusion. Voluntary HIV s creening of pregnant women and ziovudine treatment for infected women and their infants resulted in cost savings under most of the assumptio ns used in this analysis. These results strongly support implementatio n of the Public Health Service recommendations for this intervention.