Would Universal Antenatal Screeing for HIV Infection Be Cost-Effective in a Setting of Very Low Prevalence? Modelling the Data for Australia

Graves, Nicholas, Walker, Damian, McDonald, Anne M., Kaldor, John M., & Ziegler, John B. (2004) Would Universal Antenatal Screeing for HIV Infection Be Cost-Effective in a Setting of Very Low Prevalence? Modelling the Data for Australia. Journal of Infectious Diseases, 190(1), pp. 166-174.


Background: The economics of universal antenatal HIV screening should be explored if mother-to-child transmission of HIV occurs, the health service infrastructure exists for universal screening and optimal risk reducing treatments can be supplied. Published cost-effectiveness analyses of universal antenatal HIV screening conducted for high-income countries have assumed prevalence’s of >0.01%, for the base case, among the antenatal population. We model data for Australia, where prevalence is very low, to examine whether universal antenatal HIV screening is cost-effective in this setting. Methods: A static-decision-model of the incremental cost-effectiveness of universal antenatal-HIV-screening as compared to existing practice was developed. We evaluated a hypothetical cohort of the antenatal population of Australia for 2001-2002. A quasi-societal perspective was adopted, secondary data sources used and sensitivity analyses undertaken. All data relate to 2001-02 and costs and benefits incurred in the future were discounted to their present value. Results: The intervention would be cost-effective if the prevalence of undiagnosed HIV in the currently unscreened Australian antenatal population was ≥ 0.004372% (1 case in 22,872). At this prevalence, incremental costs are exactly offset by incremental benefits. We predict 6.95 new diagnoses of HIV, 1.73 infections avoided and 46.97 discounted-life-years gained. Applying favourable and unfavourable values for key variables suggests the prevalence at which the intervention would be cost-effective lies between 0.0016-0.0106% (1:62,500 – 1:9,434). Conclusions: Universal antenatal HIV screening infection would be cost-effective at a very low prevalence and would generate net benefits under many scenarios; accurate statistics on the true prevalence of HIV in the currently unscreened antenatal population are required.

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ID Code: 7720
Item Type: Journal Article
Refereed: Yes
Additional URLs:
Keywords: HIV, AIDS, cost, effectiveness analysis, economic evaluation, Australia, antenatal, screening
ISSN: 0022-1899
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > PUBLIC HEALTH AND HEALTH SERVICES (111700)
Divisions: Past > Research Centres > Centre for Health Research
Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Copyright 2004 University of Chicago Press
Copyright Statement: Reproduced in accordance with the copyright policy of the publisher.
Deposited On: 16 May 2007 00:00
Last Modified: 29 Feb 2012 13:04

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