Universal Rapid Human Immunodeficiency Virus Screening at Delivery: A Cost-Effectiveness Analysis

Area of Science:

• Public Health
• Health Economics
• Infectious Disease Epidemiology

Background:

• Mother-to-child transmission (MTCT) of HIV remains a significant public health concern.
• Current prenatal HIV screening strategies in the US vary, leading to potential gaps in early detection.
• Optimizing screening protocols is crucial for preventing new pediatric HIV infections.

Purpose of the Study:

• To evaluate the cost-effectiveness of universal rapid HIV screening at the time of delivery.
• To compare this strategy against existing prenatal screening standards of care in the United States.
• To determine the impact on quality-adjusted life years (QALYs) and overall healthcare costs.

Main Methods:

• A cost-effectiveness analysis using a decision-tree model was performed.
• Universal intrapartum rapid HIV screening was compared to two standards of care: limited third-trimester screening and no prenatal screening.
• Sensitivity analyses were conducted to assess the impact of variations in QALY, costs, and HIV incidence.

Main Results:

• The incremental cost-effectiveness ratio (ICER) for universal screening was $7,973.45 per QALY.
• Results were robust across sensitivity analyses, with the exception of very low annual cumulative incidence rates.
• At incidence rates below 0.02%, the ICER exceeded $89,926.94/QALY, nearing common cost-effectiveness thresholds.

Conclusions:

• Universal rapid HIV screening at delivery is a cost-effective intervention for decreasing MTCT.
• This strategy demonstrates particular value in populations experiencing higher HIV incidence within the United States.
• The findings support the implementation of intrapartum HIV screening to enhance maternal and child health outcomes.