Voluntary screening program for HIV in pregnancy - Cost effectiveness

OBJECTIVE: To determine the effectiveness of a voluntary human immunodefici ency virus (HIV) screening program in pregnancy. STUDY DESIGN: Using a business decision theory analysis model, we estimated the outcomes and costs of the two possible decisions by our patients (test /no test). Patients with a positive HIV screen would undergo evaluation and possible prophylactic antiviral therapy. The model was utilized to evaluat e the Naval Medical Center San Diego Program from 1995-1997. RESULTS: Prevalence of HIV in active duty Navy personnel during the years e valuated were 1995, 0.024%; 1996, 0.028%; and 1997, 0.022%. Patients screen ed for HIV during these years were 1995, 3,874; 1996, 3,924; and 1997, 4,12 7 (n = 11,925). Incidence of HIV seroprevalence in patients screened during the study period was zero. The number of patients declining HIV screening tons: 1995, 10; 1996, 8; and 2997, 5, During the same period, reported HIV seroprevalence among pregnant patients in the United States was 1.5/1,000. CONCLUSION: HIV seroprevalence in our pregnant population (zero) was lower than expected, considering the national pregnancy prevalence and Navy preva lence. The expected number of cases of positive HIV screens tons 17.8. The cost of the program for the study period was $103,748. The cost of care for one positive neonate ranges between $100,000 and $200,000.