Cost-effectiveness of elective cesarean delivery in human immunodeficiencyvirus-infected women

Objective: To evaluate the cost-effectiveness of an elective cesarean deliv ery strategy in human immunodeficiency virus (HIV)-infected women receiving zidovudine therapy to prevent perinatal transmission. Methods: A decision-analysis model was constructed to compare two delivery strategies in HIV-infected women: usual care and recommendation for electiv e cesarean delivery. The model followed a hypothetical cohort of 7000 HIV-i nfected pregnant women in the United States who were receiving zidovudine t herapy for 1 year. The third-party payer perspective was taken. Cost of del ivery method with and without complications and lifetime medical care cost for pediatric HIV infection were considered. The main outcome measure was c ases of perinatal HIV transmission prevented. Results: Compared with the usual care strategy, the elective cesarean deliv ery strategy resulted in an additional 3486 cesarean deliveries each year, prevented 142 cases (52.4%) of perinatal HIV transmission, and resulted in incremental overall cost savings to society of $5.3 million per year ($37,2 84 saved per case of perinatal transmission prevented). With other estimate s held constant, the elective cesarean delivery strategy would not be cost saving when the baseline perinatal HIV transmission rates were all reduced by 43.3%. Conclusions: Elective cesarean delivery in HIV-infected women receiving zid ovudine is one management strategy for prevention of perinatal HIV transmis sion and can be cost saving. However, if other strategies, such as use of c ombination antiretroviral therapy and/or measurement of viral load, result in at least 50% reduction of the baseline perinatal HIV transmission rates, elective cesarean delivery will not be cost saving. (Obstet Gynecol 2001;9 7:161-8. (C) 2001 by The American College of Obstetricians and Gynecologist s.).