Would universal antenatal screening for HIV infection be cost- effective in a setting of very low prevalence? Modelling the data for Australia


Graves, N; Walker, DG; McDonald, AM; Kaldor, JM; Ziegler, JB; (2004) Would universal antenatal screening for HIV infection be cost- effective in a setting of very low prevalence? Modelling the data for Australia. The Journal of infectious diseases, 190 (1). p. 166. ISSN 0022-1899 DOI: 10.1086/421247

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Abstract

Background. The economics of universal antenatal human immunodeficiency virus (HIV) screening should be explored if mother-to-child transmission of HIV occurs, the health-service infrastructure for universal screening exists, and optimal risk-reducing treatments can be supplied. Methods. We evaluated a hypothetical cohort of the antenatal population of Australia during 2001-2002, to examine whether universal antenatal HIV screening is cost-effective in this setting. A quasi-societal perspective was adopted, secondary data sources were used, and sensitivity analyses were undertaken. Costs and benefits incurred in the future were discounted to their present value. Results. The intervention would be cost-effective if the prevalence of undiagnosed HIV in the currently unscreened Australian antenatal population was greater than or equal to0.004372%. We predict 6.95 new diagnoses of HIV, 1.73 infections avoided, and 46.97 discounted-life-years gained. Applying favorable and unfavorable values for key variables suggests that the prevalence at which the intervention would be cost-effective is 0.0016%-0.0106%. Conclusions. Universal antenatal HIV screening would be cost-effective at a very low prevalence and would generate net benefits under many scenarios; accurate statistics on the true prevalence of HIV in the currently unscreened antenatal population are required.

Item Type: Article
Keywords: Human-immunodeficiency-virus, to-child transmission, randomized, clinical-trial, pregnant-women, united-kingdom, zidovudine, routine, type-1, voluntary, prevention, Australia, epidemiology, Cost-Benefit Analysis, Disease Transmission, Vertical, Female, HIV Infections, diagnosis, epidemiology, virology, Human, Mass Screening, economics, Models, Biological, Pregnancy, Pregnancy Complications, Infectious, diagnosis, epidemiology, virology, Prenatal Diagnosis, economics, Prevalence, Support, Non-U.S. Gov't, Value of Life
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
Faculty of Public Health and Policy > Dept of Global Health and Development
PubMed ID: 15195257
Web of Science ID: 222002700021
URI: http://researchonline.lshtm.ac.uk/id/eprint/14538

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