Cost effectiveness analysis of antenatal HIV screening in United Kingdom

Objective To assess the cost effectiveness of universal antenatal HIV scree ning compared with selective screening in the United Kingdom. Design Incremental cost effectiveness analysis relating additional costs of screening to life years gained. Maternal and paediatric costs and life yea rs were combined. Setting United Kingdom. Main outcome measures Number of districts for which universal screening wou ld be cost effective compared with selective screening under various condit ions. Results On base case assumptions, a new diagnosis of a pregnant woman with HIV results in a gain of 6.392 life years and additional expenditure of pou nd 14 833. If decision makers are prepared to pay up to pound 10 000 for an additional life year, this would imply a net benefit of pound 49 090 (rang e pound 12 300-pound 59 000), which would be available to detect each addit ional infected woman in an antenatal screening programme. In London, univer sal antenatal screening would be cost effective compared with a selective s creening under any reasonable assumptions about screening costs. Outside Lo ndon, universal screening with uptake above 90% would be cost effective wit h a pound 0.60 HIV antibody test cost and up to 3.5 minutes for pretest dis cussion. Cost effectiveness of universal testing is lower if selective test ing can achieve high uptake among those at higher risk. A universal strateg y with only 50% uptake may not be less cost effective in low prevalence dis tricts and may cost more and be less effective than a well run selective st rategy. Conclusions Universal screening with pretest discussion should be adopted t hroughout the United Kingdom as part of routine antenatal care as long as t est costs can be kept low and uptake high.