[Cost-effectiveness analysis of HIV screening in pregnant women in hospitals in the Paris region].

Spontaneous diffusion of HIV screening at the occasion of pregnancy has been especially rapid in France. In April-May 1988, 45% of general practitioners systematically prescribed HIV screening during premarital or prenatal consultations. Experimentation of systematic prenatal HIV screening has been performed for some time in various French maternity hospitals. On the basis of real data concerning HIV screening of more than 15,000 pregnant women between August 1987 and July 1988 in 9 Paris hospitals, a cost-effectiveness analysis has been performed. It showed that the total cost of systematic screening for women admitted to maternity hospitals for prenatal care and whose HIV status was previously unknown, was about 1.5 million French francs (about $240,000) and that 22 new cases of HIV positive were discovered. During the first five months (first period), the mean cost per pregnant woman found to be HIV positive was about 42 to 45,000 FF ($6,700-7,150). A similar calculation over the following months, gave a mean cost 4 times higher. The cost and effectiveness of a selective screening for high risk women were also estimated. In this hypothetical case, 13.6% of women would have been tested, the mean cost of discovering, at the hospital, a new HIV positive pregnant woman would have been 7,500 FF ($1,200) during the first period. The quadrupling of the mean cost of identifying an HIV positive pregnant woman by systematic hospital screening, despite a concomitant increase in prevalence in the population, can be explained only by an increase in prenatal screening prescribed by the private practitioner in ambulatory medicine before the first hospital prenatal visit. The monthly evolution of the proportion of women already screened before consultation in one of the nine maternity hospitals had increased by almost 50% between the beginning and the end of the studied period. An evaluation of a policy of HIV screening during pregnancy depends, at least in the French health care system, on the different ways the ambulatory and hospital sectors complement themselves.