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Cost-effectiveness of mandatory compared with voluntary screening for human immunodeficiency virus in pregnancy.

Publication ,  Journal Article
Myers, ER; Thompson, JW; Simpson, K
Published in: Obstet Gynecol
February 1998

OBJECTIVE: To determine the cost-effectiveness of mandatory screening for human immunodeficiency virus (HIV) in pregnancy compared with that of voluntary screening under varying assumptions about patient behavior. METHODS: Using a health care system perspective, a decision-analysis model was constructed to estimate the outcomes and costs of the two strategies. Average and incremental cost-effectiveness ratios were calculated for each strategy. Sensitivity analyses were performed to test the effects of different values on the results of the simulation. In particular, we examined the potential effects of changes in patient behavior resulting from mandatory screening on our estimates of cost-effectiveness. RESULTS: At a prevalence of 170 per 100,000, average costs per case prevented were $255,158 and $367,998 for mandatory and voluntary screening, respectively. The incremental cost-effectiveness of mandatory compared with voluntary screening was $29,478. These values decreased as prevalence of HIV increased, or as the estimated lifetime cost of pediatric HIV infection increased: above an estimated cost for pediatric HIV of $129,250, mandatory screening was less expensive and more effective than voluntary screening. Assumptions about patient behavior affected these results: a 40% reduction in zidovudine acceptance in women identified only through mandatory screening increased the incremental cost-effectiveness to $112,434. The impact of behavior increased as the prevalence of HIV increased. CONCLUSION: Mandatory screening will prevent more cases of pediatric AIDS, but at a somewhat higher cost than voluntary screening under baseline assumptions. The cost-effectiveness of mandatory screening will be influenced by patient behavior, especially acceptance of zidovudine treatment among women who would have refused voluntary screening.

Duke Scholars

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Published In

Obstet Gynecol

DOI

ISSN

0029-7844

Publication Date

February 1998

Volume

91

Issue

2

Start / End Page

174 / 181

Location

United States

Related Subject Headings

  • Zidovudine
  • Pregnancy Complications, Infectious
  • Pregnancy
  • Obstetrics & Reproductive Medicine
  • Mandatory Testing
  • Infectious Disease Transmission, Vertical
  • Humans
  • Health Care Costs
  • Health Behavior
  • HIV Infections
 

Citation

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Myers, E. R., Thompson, J. W., & Simpson, K. (1998). Cost-effectiveness of mandatory compared with voluntary screening for human immunodeficiency virus in pregnancy. Obstet Gynecol, 91(2), 174–181. https://doi.org/10.1016/s0029-7844(97)00629-7
Myers, E. R., J. W. Thompson, and K. Simpson. “Cost-effectiveness of mandatory compared with voluntary screening for human immunodeficiency virus in pregnancy.Obstet Gynecol 91, no. 2 (February 1998): 174–81. https://doi.org/10.1016/s0029-7844(97)00629-7.
Myers ER, Thompson JW, Simpson K. Cost-effectiveness of mandatory compared with voluntary screening for human immunodeficiency virus in pregnancy. Obstet Gynecol. 1998 Feb;91(2):174–81.
Myers, E. R., et al. “Cost-effectiveness of mandatory compared with voluntary screening for human immunodeficiency virus in pregnancy.Obstet Gynecol, vol. 91, no. 2, Feb. 1998, pp. 174–81. Pubmed, doi:10.1016/s0029-7844(97)00629-7.
Myers ER, Thompson JW, Simpson K. Cost-effectiveness of mandatory compared with voluntary screening for human immunodeficiency virus in pregnancy. Obstet Gynecol. 1998 Feb;91(2):174–181.
Journal cover image

Published In

Obstet Gynecol

DOI

ISSN

0029-7844

Publication Date

February 1998

Volume

91

Issue

2

Start / End Page

174 / 181

Location

United States

Related Subject Headings

  • Zidovudine
  • Pregnancy Complications, Infectious
  • Pregnancy
  • Obstetrics & Reproductive Medicine
  • Mandatory Testing
  • Infectious Disease Transmission, Vertical
  • Humans
  • Health Care Costs
  • Health Behavior
  • HIV Infections