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July 10, 1996, Vol 276, No. 2 >
ARTICLE | July 10, 1996

Economic Impact of Treatment of HIV-Positive Pregnant Women and Their Newborns With Zidovudine: Title and subTitle BreakImplications for HIV Screening FREE

Josephine A. Mauskopf, PhD; John E. Paul, PhD; Daniel S. Wichman; Alice D. White, PhD; Hugh H. Tilson, MD, DrPH
[+] Author Affiliations

Drs Mauskopf, Paul, White, and Tilson are employed at Glaxo Wellcome Inc, which manufactures zidovudine under the name Retrovir. Dr Tilson has Glaxo Wellcome Inc stock and stock options. Drs Paul, Mauskopf, and White have Glaxo Wellcome Inc stock options. Mr Wichman was a summer intern at Burroughs Wellcome Co at the time the article was drafted and has no stock options in Glaxo Wellcome Inc.

Reprints: Josephine Mauskopf, PhD, Glaxo Wellcome Inc, 5 Moore Dr, Research Triangle Park, NC 27709.


JAMA. 1996;276(2):132-138. doi:10.1001/jama.1996.03540020054029
Text Size: A A A
Published online
Article
References

Objectives.  —To estimate the economic impact of (1) treating pregnant women who are human immunodeficiency virus (HIV)-positive with zidovudine and (2) voluntary screening programs for pregnant women for HIV infection and offering treatment with zidovudine to those found to be HIV-positive.

Main Outcome Measures.  —Number of cases of pediatric HIV infection and costs of screening, zidovudine treatment, and pediatric HIV infection treatment.

Design.  —Health care costs associated with treatment of HIV-positive pregnant women and their newborns are estimated as the costs of zidovudine and its administration and the reduction in costs of treating pediatric HIV infection. The lifetime costs of pediatric HIV infection are derived from the published literature. Estimates of the reduction in maternal-to-fetal transmission rates are taken from the AIDS [acquired immunodeficiency syndrome] Clinical Trials Group (ACTG) Protocol 076. Costs of a voluntary screening program include costs of screening tests and counseling. Sensitivity and threshold analyses are performed to determine the impact of changes in input parameter values including zidovudine treatment costs, efficacy of treatment, costs of pediatric HIV infection, prevalence of HIV infection in pregnant women, screening test sensitivity and specificity, and pregnancy termination rates on the results.

Results.  —Assuming transmission rates are reduced from 25.5% to 8.3% as found in the ACTG 076 trial, treatment costs of $104 502 for 100 HIV-positive pregnant women and their newborns are offset by the reduction of $1 701 333 associated with fewer cases of pediatric HIV infection for a net savings of $1 596 831. The sensitivity and threshold analyses show that overall cost savings from treatment of HIV-positive pregnant women and their newborns are achieved for a wide range of possible maternal treatment costs, efficacy rates, and lifetime pediatric HIV treatment costs. In the base-case analysis for the voluntary screening program, overall cost savings are seen when the HIV prevalence rate among pregnant women is greater than 4.6 per 1000. However, this threshold prevalence rate is sensitive to changes in parameter values—especially pediatric HIV treatment costs, counseling costs, efficacy of treatment, and years of additional HIV treatment for the pregnant women.

Conclusions.  —Offering zidovudine treatment to pregnant women known to be HIV-positive will decrease the number of cases of pediatric HIV infection and reduce health care costs. Voluntary screening programs for pregnant women will further decrease the number of cases of pediatric HIV infection. The effect of a screening program on health care costs varies according to HIV prevalence and the costs associated with the screening program.

REFERENCES

1 +
 Centers for Disease Control and Prevention . National HIV Serosurveillance Summary: Results Through 1992 . Atlanta, Ga: US Dept of Health and Human Services, Public Health Service; 1994;:vol 3.
2 +
Yogev R, Connor E, eds. Management of HIV Infection in Infants and Children . St Louis, Mo: Mosby-Year Book; 1992;:8-19.
3 +
The European Collaborative Study.  Natural history of vertically acquired human immunodeficiency virus-1 infection . Pediatrics . 1994;;94:815-819.
4 +
Frederick T, Mascola L, Eller A, et al.  Progression of human immunodeficiency virus disease among infants and children infected perinatally with human immunodeficiency virus or through neonatal blood transfusion . Pediatr Infect Dis J . 1994;;13:1091-1097.
5 +
Stein Z.  HIV prevention: an update on the status of methods women can use . Am J Public Health . 1993;;83:1379-1382.
6 +
Connor EM, Sperling RS, Gelber R, et al, for the Pediatric AIDS Clinical Trials Group Protocol 076 Study Group.  Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment . N Engl J Med . 1994;;331:1173-1180.
7 +
Centers for Disease Control and Prevention.  Recommendations for the use of zidovudine to reduce perinatal transmission of human immunodeficiency virus . MMWR Morb Mortal Wkly Rep . 1994;;43(RR11):1-20.
8 +
Garrett HM, ed. 1994 Red Book . Montvale, NJ: Medical Economics Data; August 1994;:48.
9 +
Parrott RH.  Childhood human immunodeficiency virus infection: the spectrum of costs . J Acquir Immune Defic Syndr . 1991;;4:122-129.
10 +
Hegarty JD, Abrams EJ, Hutchinson VE, et al.  The medical care costs of human immunodeficiency virus-infected children in Harlem . JAMA . 1988;;260:1901-1909.
11 +
Hsia D, Fleishman J, East J, Hellinger F.  Pediatric human immunodeficiency virus infection . Arch Pediatr Adolesc Med . 1995;;149:489-496.
12 +
Andrulis D, Weslowski V, Hintz E, Spolarich A.  Comparisons of hospital care for patients with AIDS and other HIV-related conditions . JAMA . 1992;;267:2482-2486.
13 +
Statistical Abstract of the United States: 1995. 115th ed. Washington, DC: US Bureau of the Census; 1995:494,Table 762.
14 +
Barnhart H, Caldwell B, Thomas P, et al. HIV progression in perinatally infected children. Presented at the Second Conference on Retroviruses and Opportunistic Infections; February 1, 1995; Washington, DC. Abstract 575.
15 +
Havens PL, Cuene BE, Hand JR. Lifetime cost for children with HIV infection. Presented at the Third Conference on Antiretrovirals and Opportunistic Infections; January 30,1996; Washington, DC. Abstract 272.
16 +
Gwinn M, Wasser S, Fleming P, Karon J, Peterson L. Increasing prevalence of HIV infection among childbearing women, United States, 1989-1991. In: Program and abstracts of the Ninth International Conference on AIDS; June 6-June 11, 1993; Berlin, Germany. Abstract No. PO-C16-2990.
17 +
Hardy LM, ed. HIV Screening of Pregnant Women and Newborns . Washington, DC: Committee on Prenatal and Newborn Screening for HIV Infection, Institute of Medicine, National Academy Press; 1991;.
18 +
Ventura SJ, Martin JA, Taffel SM, et al. Advance report of final natality statistics, 1993. Vital Health Stat 3. Hyattsville, Md: National Center for Health Statistics; 1995; No.44(suppl 1995): Table 33.
19 +
Lindsay MK, Feng TI, Peterson HB, et al.  Routine human immunodeficiency virus infection screening in unregistered and registered inner-city parturients . Obstet Gynecol . 1991;;77:599-603.
20 +
Barbacci MB, Dalabetta GA, Repke JT, et al.  Human immunodeficiency virus infection in women attending an inner-city prenatal clinic . Sex Transm Dis . 1990;;17:122-126.
21 +
Barbacci M, Repke JT, Chaisson RE.  Routine prenatal screening for HIV infection . Lancet . 1991;; 337:709-711.
22 +
Fehrs LJ, Hill D, Kerndt PR, et al.  Targeted HIV screening at a Los Angeles prenatal/family planning health center . Am J Public Health . 1991;;81:619-622.
23 +
Lindsay MK, Adefris W, Peterson HB, et al.  Determinants of acceptance of routine voluntary human immunodeficiency virus testing in an inner-city prenatal patient population . Obstet Gynecol . 1989;;78:678-680.
24 +
Cozen W, Mascola L, Enguidanos R, et al.  Screening for HIV and hepatitis B virus in Los Angeles County prenatal clinics: a demonstration project . J Acquir Immune Defic Syndr . 1993;;6:95-98.
25 +
Hedlund K, Spencer J, Schalla W, et al. Estimated public costs of HIV counseling and testing, USA. In: Program and abstracts of the Sixth International Conference on AIDS; June 20-24,1990; San Francisco, Calif. Abstract FD835.
26 +
Phillips KA, Lowe RA, Kahn JG, et al.  The costeffectiveness of HIV testing of physicians and dentists in the United States . JAMA . 1994;;271:851-858.
27 +
Lurie P, Avins AL, Phillips KA, et al.  The costeffectiveness of voluntary counseling and testing of hospital inpatients for HIV infection . JAMA . 1994;; 272:1832-1838.
28 +
Brown AE, Burke DS.  Cost of HIV testing in the US Army . N Engl J Med . 1995;;332:963.
29 +
McCarthy BD, Wong JB, Munoz A, et al.  Who should be screened for HIV infection? Arch Intern Med . 1993;;153:1107-1116.
30 +
Brandeau ML, Owens DK, Sox CH, et al.  Screening women of childbearing age for human immunodeficiency virus . Arch Intern Med . 1992;;152:2229-2237.
31 +
Turnock BJ, Kelly CJ.  Mandatory premarital testing for human immunodeficiency virus: the Illinois experience . JAMA . 1989;;261:3415-3418.
32 +
Weber B, Hess G, Koberstein R, Doerr HW.  Evaluation of the automated 'Enzymen-Test Anti HIV-1+2' and 'Enzymen-Test Anti HIV-1/2 selective' for the combined detection and differentiation of anti-HIV-1 and anti-HIV-2 antibodies . J Virol Methods . 1993;;44:251-260.
33 +
Gwinn M, Redus MA, Granade TC, et al.  HIV-1 serologic test results for one million newborn driedblood specimens . J Acquir Immune Defic Syndr . 1992;;5:505-512.
34 +
Holtgrave DR, Valdiserri RO, Gerber AR, et al.  Human immunodeficiency virus counseling, testing, referral, and partner notification services: a cost benefit analysis . Arch Intern Med . 1993;;153:1225-1230.
35 +
MacDonald KL, Jackson JB, Bowman RJ, et al.  Performance charcteristics of serologic tests for human immunodeficiency virus type 1 (HIV-1) antibody among Minnesota blood donors . Ann Intern Med . 1989;;110:617-621.
36 +
Burke DS, Brundage JF, Redfield RR, et al.  Measurement of false-positive rates in a screening program for human immunodeficiency virus infections . N Engl J Med . 1988;;319:961-964.
37 +
Hellinger F.  The lifetime cost of treating a person with HIV . JAMA . 1993;;270:474-478.
38 +
Faden R, Gielen A, Kass N, O'Campo P, Sheon A.  Reproductive preferences of pregnant women under shifting probabilities of vertical HIV transmission . Wom Health Issues . 1993;;3:216-222.
39 +
Selwyn P, Carter R, Shoenbaum E, Robertson V, Klein R, Rogers M.  Knowledge of HIV antibody status and decisions to continue of terminate pregnancy among intravenous drug users . JAMA . 1989;; 261:3567-3571.
40 +
Johnstone F, Brettle R, MacCallum L, Mok J, Peutherer J, Burns S.  Women's knowledge of their HIV antibody status: its effect on their decision whether to continue their pregnancy . BMJ . 1990;: 300:23-24.
41 +
Bloom DE, Glied S.  Benefits and costs of HIV testing . Science . 1991;;252:1798-1804.
42 +
Chavey WE, Cantor SB, Clover RD, et al.  Costeffectiveness analysis of screening health care workers for HIV . J Fam Pract . 1994;;38:249-257.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
 Centers for Disease Control and Prevention . National HIV Serosurveillance Summary: Results Through 1992 . Atlanta, Ga: US Dept of Health and Human Services, Public Health Service; 1994;:vol 3.
2 +
Yogev R, Connor E, eds. Management of HIV Infection in Infants and Children . St Louis, Mo: Mosby-Year Book; 1992;:8-19.
3 +
The European Collaborative Study.  Natural history of vertically acquired human immunodeficiency virus-1 infection . Pediatrics . 1994;;94:815-819.
4 +
Frederick T, Mascola L, Eller A, et al.  Progression of human immunodeficiency virus disease among infants and children infected perinatally with human immunodeficiency virus or through neonatal blood transfusion . Pediatr Infect Dis J . 1994;;13:1091-1097.
5 +
Stein Z.  HIV prevention: an update on the status of methods women can use . Am J Public Health . 1993;;83:1379-1382.
6 +
Connor EM, Sperling RS, Gelber R, et al, for the Pediatric AIDS Clinical Trials Group Protocol 076 Study Group.  Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment . N Engl J Med . 1994;;331:1173-1180.
7 +
Centers for Disease Control and Prevention.  Recommendations for the use of zidovudine to reduce perinatal transmission of human immunodeficiency virus . MMWR Morb Mortal Wkly Rep . 1994;;43(RR11):1-20.
8 +
Garrett HM, ed. 1994 Red Book . Montvale, NJ: Medical Economics Data; August 1994;:48.
9 +
Parrott RH.  Childhood human immunodeficiency virus infection: the spectrum of costs . J Acquir Immune Defic Syndr . 1991;;4:122-129.
10 +
Hegarty JD, Abrams EJ, Hutchinson VE, et al.  The medical care costs of human immunodeficiency virus-infected children in Harlem . JAMA . 1988;;260:1901-1909.
11 +
Hsia D, Fleishman J, East J, Hellinger F.  Pediatric human immunodeficiency virus infection . Arch Pediatr Adolesc Med . 1995;;149:489-496.
12 +
Andrulis D, Weslowski V, Hintz E, Spolarich A.  Comparisons of hospital care for patients with AIDS and other HIV-related conditions . JAMA . 1992;;267:2482-2486.
13 +
Statistical Abstract of the United States: 1995. 115th ed. Washington, DC: US Bureau of the Census; 1995:494,Table 762.
14 +
Barnhart H, Caldwell B, Thomas P, et al. HIV progression in perinatally infected children. Presented at the Second Conference on Retroviruses and Opportunistic Infections; February 1, 1995; Washington, DC. Abstract 575.
15 +
Havens PL, Cuene BE, Hand JR. Lifetime cost for children with HIV infection. Presented at the Third Conference on Antiretrovirals and Opportunistic Infections; January 30,1996; Washington, DC. Abstract 272.
16 +
Gwinn M, Wasser S, Fleming P, Karon J, Peterson L. Increasing prevalence of HIV infection among childbearing women, United States, 1989-1991. In: Program and abstracts of the Ninth International Conference on AIDS; June 6-June 11, 1993; Berlin, Germany. Abstract No. PO-C16-2990.
17 +
Hardy LM, ed. HIV Screening of Pregnant Women and Newborns . Washington, DC: Committee on Prenatal and Newborn Screening for HIV Infection, Institute of Medicine, National Academy Press; 1991;.
18 +
Ventura SJ, Martin JA, Taffel SM, et al. Advance report of final natality statistics, 1993. Vital Health Stat 3. Hyattsville, Md: National Center for Health Statistics; 1995; No.44(suppl 1995): Table 33.
19 +
Lindsay MK, Feng TI, Peterson HB, et al.  Routine human immunodeficiency virus infection screening in unregistered and registered inner-city parturients . Obstet Gynecol . 1991;;77:599-603.
20 +
Barbacci MB, Dalabetta GA, Repke JT, et al.  Human immunodeficiency virus infection in women attending an inner-city prenatal clinic . Sex Transm Dis . 1990;;17:122-126.
21 +
Barbacci M, Repke JT, Chaisson RE.  Routine prenatal screening for HIV infection . Lancet . 1991;; 337:709-711.
22 +
Fehrs LJ, Hill D, Kerndt PR, et al.  Targeted HIV screening at a Los Angeles prenatal/family planning health center . Am J Public Health . 1991;;81:619-622.
23 +
Lindsay MK, Adefris W, Peterson HB, et al.  Determinants of acceptance of routine voluntary human immunodeficiency virus testing in an inner-city prenatal patient population . Obstet Gynecol . 1989;;78:678-680.
24 +
Cozen W, Mascola L, Enguidanos R, et al.  Screening for HIV and hepatitis B virus in Los Angeles County prenatal clinics: a demonstration project . J Acquir Immune Defic Syndr . 1993;;6:95-98.
25 +
Hedlund K, Spencer J, Schalla W, et al. Estimated public costs of HIV counseling and testing, USA. In: Program and abstracts of the Sixth International Conference on AIDS; June 20-24,1990; San Francisco, Calif. Abstract FD835.
26 +
Phillips KA, Lowe RA, Kahn JG, et al.  The costeffectiveness of HIV testing of physicians and dentists in the United States . JAMA . 1994;;271:851-858.
27 +
Lurie P, Avins AL, Phillips KA, et al.  The costeffectiveness of voluntary counseling and testing of hospital inpatients for HIV infection . JAMA . 1994;; 272:1832-1838.
28 +
Brown AE, Burke DS.  Cost of HIV testing in the US Army . N Engl J Med . 1995;;332:963.
29 +
McCarthy BD, Wong JB, Munoz A, et al.  Who should be screened for HIV infection? Arch Intern Med . 1993;;153:1107-1116.
30 +
Brandeau ML, Owens DK, Sox CH, et al.  Screening women of childbearing age for human immunodeficiency virus . Arch Intern Med . 1992;;152:2229-2237.
31 +
Turnock BJ, Kelly CJ.  Mandatory premarital testing for human immunodeficiency virus: the Illinois experience . JAMA . 1989;;261:3415-3418.
32 +
Weber B, Hess G, Koberstein R, Doerr HW.  Evaluation of the automated 'Enzymen-Test Anti HIV-1+2' and 'Enzymen-Test Anti HIV-1/2 selective' for the combined detection and differentiation of anti-HIV-1 and anti-HIV-2 antibodies . J Virol Methods . 1993;;44:251-260.
33 +
Gwinn M, Redus MA, Granade TC, et al.  HIV-1 serologic test results for one million newborn driedblood specimens . J Acquir Immune Defic Syndr . 1992;;5:505-512.
34 +
Holtgrave DR, Valdiserri RO, Gerber AR, et al.  Human immunodeficiency virus counseling, testing, referral, and partner notification services: a cost benefit analysis . Arch Intern Med . 1993;;153:1225-1230.
35 +
MacDonald KL, Jackson JB, Bowman RJ, et al.  Performance charcteristics of serologic tests for human immunodeficiency virus type 1 (HIV-1) antibody among Minnesota blood donors . Ann Intern Med . 1989;;110:617-621.
36 +
Burke DS, Brundage JF, Redfield RR, et al.  Measurement of false-positive rates in a screening program for human immunodeficiency virus infections . N Engl J Med . 1988;;319:961-964.
37 +
Hellinger F.  The lifetime cost of treating a person with HIV . JAMA . 1993;;270:474-478.
38 +
Faden R, Gielen A, Kass N, O'Campo P, Sheon A.  Reproductive preferences of pregnant women under shifting probabilities of vertical HIV transmission . Wom Health Issues . 1993;;3:216-222.
39 +
Selwyn P, Carter R, Shoenbaum E, Robertson V, Klein R, Rogers M.  Knowledge of HIV antibody status and decisions to continue of terminate pregnancy among intravenous drug users . JAMA . 1989;; 261:3567-3571.
40 +
Johnstone F, Brettle R, MacCallum L, Mok J, Peutherer J, Burns S.  Women's knowledge of their HIV antibody status: its effect on their decision whether to continue their pregnancy . BMJ . 1990;: 300:23-24.
41 +
Bloom DE, Glied S.  Benefits and costs of HIV testing . Science . 1991;;252:1798-1804.
42 +
Chavey WE, Cantor SB, Clover RD, et al.  Costeffectiveness analysis of screening health care workers for HIV . J Fam Pract . 1994;;38:249-257.

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