Cost-effectiveness of cesarean section delivery to prevent mother-to-childtransmission of HIV-1

Objective: To evaluate costs and outcomes of cesarean section performed bef ore onset of labor and before rupture of membranes (elective cesarean secti on) compared to vaginal delivery among HIV-infected women. Design: Cost-effectiveness and cost-benefit analysis. Participants and setting: Pregnant HIV-infected women in the US who refrain from breastfeeding. Intervention: Elective cesarean section versus vaginal delivery by antiretr oviral therapy regimen. Main outcome measures: Pediatric HIV cases avoided, years of life saved, an d direct medical costs for maternal interventions and pediatric HIV treatme nt. Results: Elective cesarean section (versus vaginal delivery) was cost-effec tive among women receiving zidovudine prophylaxis (US$1131 per case avoided , US$17 per year of life saved) and combination antiretroviral therapy (US$ 112 693 per case avoided, US$1697 per year of life saved), and cost saving among women receiving no antiretroviral therapy during pregnancy (benefit-c ost ratio of 2.23). Although elective cesarean section remained cost-effect ive, results were sensitive to variations in vertical transmission rates an d to pediatric HIV treatment costs. Population-based analyses indicated tha t elective cesarean section could prevent 239 pediatric HIV cases annually with a savings of over US$4 million. Conclusions: Elective cesarean section is a cost-effective intervention to prevent vertical transmission of HIV among women receiving various antiretr oviral therapy regimens, who refrain from breastfeeding. (C) 2000 Lippincot t Williams & Wilkins.