This presentation is part of: Oral Concurrent Session B - Screening in Chronic Disease
COST-EFFECTIVENESS OF HIV RESCREENING DURING LATE PREGNANCY TO PREVENT PERINATAL HIV TRANSMISSION IN A RESOURCE-LIMTED COUNTRY
Sada Soorapanth, PhD and Stephanie Sansom, PhD. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
PURPOSE: To assess the cost effectiveness of HIV rescreening during late pregnancy to prevent perinatal HIV transmission in South Africa, a country with high HIV prevalence and incidence among pregnant women. METHODS: A decision-analysis model, from a healthcare system perspective, was used to compare the marginal costs and effectiveness of an HIV rescreening strategy during late pregnancy (at 36 weeks or at labor and delivery in addition to an initial test at 24 weeks) with an initial test only early in pregnancy. Because pediatric antiretroviral use is becoming more widely available in South Africa for HIV-infected children, scenarios in which pediatric antiretroviral therapy (ART) was and was not available were analyzed. Sensitivity analysis, based on statistical experimental design technique, is used to estimate the effects of input parameters on outcomes. RESULTS: At a national average HIV prevalence of 26.5% and annual incidence of 2.7% among pregnant women in South Africa, HIV rescreening would prevent an additional 14 infant infections, and increase program costs by US$18,271 per 10,000 pregnant women tested. If pediatric ART is available, the rescreening would avert disease costs by US$42,768, resulting in a net savings of US$24,500 per 10,000 pregnant women. If pediatric ART is not available, the rescreening would avert pediatric disease treatment costs by US$4,541 per 10,000 pregnant women, resulting in a marginal cost of US$44 per life-year saved. The cost and effectiveness are sensitive to the costs of infant formula and the medical care of HIV-infected children, as well as the probabilities of test acceptance and adherence to peripartum antiretroviral prophylaxis. CONCLUSIONS: Under the more likely scenario, where pediatric ART is available, HIV rescreening during late pregnancy is cost saving, and the result is robust over wide ranges of parameter values. Without the availability of pediatric ART, rescreening incurs an acceptable cost per infant life-year saved; however, the result is sensitive to variations in parameters. Overall, screening pregnant women twice for HIV in high HIV prevalence, resource-limited settings, appears to be a cost-effective strategy for reducing mother-to-child transmission.
