Postma M J, Beck E J, Hankins C A, Mandalia S, Jager J C, de Jong-van den Berg L T, Walters M D, Sherr L
Groningen University Institute for Drug Exploration/Groningen Research Institute of Pharmacy, The Netherlands.
AIDS. 2000 Oct 20;14(15):2383-9. doi: 10.1097/00002030-200010200-00020.
Recently the Department of Health announced the introduction in England of voluntary universal HIV screening in early pregnancy to prevent vertical transmission. New data have shown the importance of HIV infection in infants born to mothers who were HIV-negative in early pregnancy and who acquired HIV later in pregnancy or during lactation. This requires consideration of repeat testing in late pregnancy and testing of partners of pregnant women (expanded antenatal HIV testing).
To estimate cost effectiveness of expanded antenatal HIV testing in London (England) within the framework of universal voluntary HIV screening in early pregnancy.
Incremental cost-effectiveness analysis.
Cost estimates of service provision for HIV-positive children and adults by stage of HIV infection were combined with estimates of health benefits for infants and parents and with costs of counselling and testing (testing costs). In a pharmacoeconomic model cost effectiveness was estimated for expanded antenatal HIV testing in London for universal and selective strategies.
Testing costs in the plausible range of pounds sterling 4 to pounds sterling 40 translate into favourable incremental cost-effectiveness estimates for expanded antenatal HIV testing in London which is already at low numbers of vertical transmissions averted per 100000 pregnant women who test HIV-negative in early pregnancy. Favourable cost effectiveness for universal expanded testing would require testing costs in the lower range, whereas selective expanded testing may produce favourable cost effectiveness at testing costs close to pounds sterling 40.
Based on pharmaco-economic considerations, the authors believe that implementation of expanded HIV testing in London should be considered.
最近，英国卫生部宣布在英格兰推行早孕自愿普遍艾滋病毒筛查，以预防垂直传播。新数据显示，对于孕早期艾滋病毒检测呈阴性、但在孕期后期或哺乳期感染艾滋病毒的母亲所生婴儿，艾滋病毒感染具有重要影响。这就需要考虑在孕晚期进行重复检测以及对孕妇伴侣进行检测（扩大产前艾滋病毒检测）。
评估在早孕自愿普遍艾滋病毒筛查框架下，伦敦（英国）扩大产前艾滋病毒检测的成本效益。
增量成本效益分析。
将按艾滋病毒感染阶段划分的艾滋病毒阳性儿童和成人的服务提供成本估计数，与婴儿和父母的健康效益估计数以及咨询和检测成本（检测成本）相结合。在一个药物经济学模型中，估计了伦敦扩大产前艾滋病毒检测采用普遍和选择性策略的成本效益。
检测成本在4英镑至40英镑的合理范围内，对于伦敦扩大产前艾滋病毒检测而言，可转化为有利的增量成本效益估计数，而伦敦每100000名孕早期艾滋病毒检测呈阴性的孕妇中，已能避免少量垂直传播。普遍扩大检测要实现有利的成本效益，检测成本需处于较低范围，而选择性扩大检测在检测成本接近40英镑时可能产生有利的成本效益。
基于药物经济学考虑，作者认为应考虑在伦敦实施扩大艾滋病毒检测。
