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Economic impact of routine opt-out antenatal human immune deficiency virus screening: A systematic review
Everistus Ibekwe1, Carol Haigh1, Fiona Duncan2
1Nursing Department, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK.
Insights
Routine antenatal screening for human immune deficiency virus (HIV) is cost-effective and saves money. Early identification of maternal HIV status is crucial for preventing mother-to-child transmission and minimizing healthcare costs.
Area of Science:
- Public Health
- Health Economics
- Infectious Disease Epidemiology
Background:
- Mother-to-child transmission of human immune deficiency virus (HIV) is a significant concern, with many infections preventable through timely maternal HIV status identification and intervention.
- Routine HIV testing in antenatal settings is promoted globally for universal access, yet its economic impact requires careful evaluation.
Purpose of the Study:
- To assess the economic impact of implementing routine human immune deficiency virus (HIV) testing for pregnant women in antenatal care settings.
Main Methods:
- A systematic review of published literature from 1998 to 2015 was conducted.
- Searches were performed across multiple databases (Science Direct, MEDLINE, SCOPUS, JSTOR, CINAHL, PubMed) with no geographical restrictions, limited to English language articles.
- Manual searches supplemented electronic findings to ensure comprehensive inclusion of high-quality materials.
Main Results:
- Ten eligible articles out of fifty-five retrieved indicated that routine antenatal HIV testing programs are generally cost-effective and cost-saving compared to alternative strategies.
- Studies reported significant cost savings, ranging from $5,761.20 to $3.69 million per prevented case of undiagnosed maternal HIV infection.
- The cost-effectiveness of these programs was strongly correlated with the prevalence rate of HIV in the studied populations.
Conclusions:
- Routine antenatal HIV testing is demonstrably cost-effective and cost-saving, offering a valuable strategy for public health.
- Standardized reporting formats are needed to improve the comparability and generalizability of economic evaluations in this field.
- Prioritizing early detection of prenatal HIV is essential for reducing mother-to-child transmission efficiently within healthcare budgets.
Aims And Objectives:
To evaluate the economic impact of routine testing of human immune deficiency virus in antenatal settings.
Background:
Many children are being infected with human immune deficiency virus through mother-to-child transmission of the virus. Most of these infections are preventable if the mothers' human immune deficiency virus status is identified in a timely manner and appropriate interventions put in place. Routine human immune deficiency virus testing is widely acclaimed as a strategy for universal access to human immune deficiency virus testing and is being adopted by developed and developing poor income countries without recourse to the economic impact.
Design:
A systematic review of published articles.
Methods:
Extensive electronic searches for relevant journal articles published from 1998-2015 when countries began to implement routine antenatal HIV testing on their own were conducted in the following databases: Science Direct, MEDLINE, SCOPUS, JSTOR, CINAHL and PubMed with search terms as listed in Box 2. Manual searches were also performed to complement the electronic identification of high-quality materials. There were no geographical restrictions, but language was limited to English.
Results:
Fifty-five articles were retrieved; however, ten were eligible and included in the review. The findings showed that many programmes involving routine human immune deficiency virus testing for pregnant women compared to the alternatives were cost-effective and cost saving. Data from the reviewed studies showed cost savings between $5,761.20-$3.69 million per case of previously undiagnosed maternal human immune deficiency virus-positive infection prevented. Overall, cost-effectiveness was strongly associated with the prevalence rate of human immune deficiency virus in the various settings.
Conclusions:
Routine human immune deficiency virus testing is both cost-effective and cost saving compared to the alternatives. However, there are wide variations in the methodological approaches to the studies. Adopting standard reporting format would facilitate comparison between studies and generalisability of economic evaluations.
Relevance To Clinical Practice:
(i) Healthcare decision-makers should understand that routine antenatal screening for human immune deficiency virus is both cost-effective and cost saving. (ii) Addressing late identification of prenatal human immune deficiency virus is crucial to reducing mother-to-child transmission at minimal healthcare spending.
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