BMJ 1999;318:1656-1660 ( 19 June )

Papers

Universal HIV screening of pregnant women in England: cost effectiveness analysis

Papers pp   1650 , 1660

M J Postma, econometrician, a E J Beck, senior lecturer, c S Mandalia, research assistant in statistics, c L Sherr, senior lecturer, e M D S Walters, senior lecturer, d H Houweling, epidemiologist, b J C Jager, biomathematician. a

a National Institute of Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, Netherlands Department of Health Services Research, b Department of Infectious Diseases Epidemiology, c Imperial College School of Medicine (St Mary's Campus), London W2 1PG Department of Epidemiology and Public Health, d Department of Paediatrics, e Department of Primary Care and Population Science, Royal Free Hospital School of Medicine, London NW3 2PF

Correspondence to: Dr Beck e.beck{at}ic.ac.uk

Objective: To estimate the cost effectiveness of universal, voluntary HIV screening of pregnant women in England.
Design: Cost effectiveness analysis. Cost estimates of caring for HIV positive children were based on the stage of HIV infection and calculated using data obtained from a London hospital between 1986 and 1996. These were combined with estimates of the health benefits and costs of antenatal screening so that the cost effectiveness of universal, voluntary antenatal screening for HIV infection in England could be estimated.
Main outcome measures: Lifetime, direct costs of medical care of childhood HIV infection; life years gained as a result of the screening programme; net cost per life year gained for different pretest counselling costs; and different prevalence rates of pregnant women who were unaware that they were HIV positive.
Results: Estimated direct lifetime medical and social care costs of childhood HIV infection were £178 300 using a 5% discount rate for time preference (1995-6 prices). In high prevalence areas screening pregnant women for HIV is estimated to be a cost effective intervention with a net cost of less than £4000 for each life year gained. For areas with comparatively low prevalence rates, cost effectiveness could be less than £20 000 per life year gained, depending on the number of pregnant women who are unaware that they are infected and local screening costs.
Conclusions: Our results confirm recent recommendations that universal, voluntary antenatal HIV screening should be implemented in the London area. Serious consideration of the policy should be given for other areas in England depending on local prevalence and screening costs.


Key Messages

  • The lifetime costs of care for a child infected with HIV have been estimated at £178 300

  • Screening pregnant women for HIV can avert this cost and lead to gains in life years for both mothers and children

  • Universal, voluntary antenatal HIV screening is estimated to be a cost effective intervention with cost saving potential in areas in which there is a high prevalence of HIV infection among pregnant women

  • In areas with lower prevalence rates, cost effectiveness could be well below £20 000 per life year gained, and universal, voluntary antenatal screening could be considered




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