Chowers Michal, Shavit Oren
Infectious Diseases Unit, Meir Medical Center, Kfar Saba and the Sackler Medical School, Tel-Aviv University, Ramat Aviv, Israel.
Meuhedet Health Fund, Tel Aviv and the School of Pharmacy, The Hebrew University of Jerusalem, Jerusalem, Israel.
Sex Transm Infect. 2017 Mar;93(2):112-117. doi: 10.1136/sextrans-2015-052497. Epub 2016 Oct 7.
Our objective was to economically evaluate universal HIV prenatal screening in Israel, a very low prevalence country (0.1%), compared with the current policy of testing only women belonging to high-risk (HR) groups.
A cost-effectiveness analytical model was constructed. Life expectancies, direct medical costs and utility weights of an HIV-positive newborn and a healthy newborn were derived from the literature. Screening was assessed using fourth-generation combo tests. Structural uncertainties were discussed with leading Israeli HIV experts. Univariate and multivariate sensitivity analyses were conducted to account for uncertainty of the model's parameters.
Under the current policy, about 2700 women are tested annually identifying 27 HIV-positive women. With the universal screening, 171 000 women would be tested yearly identifying 37 as HIV positive. The analysis included the increased life expectancy of vertically infected children based on current standards of care. Over the lifetime expectancy, universal screening is projected to grant 15 additional quality-adjusted life years and save $177 521 when compared with the current HR only policy.
Universal prenatal HIV screening is projected to be cost saving in Israel, despite a very low HIV prevalence in the general population.
我们的目标是对以色列（一个艾滋病病毒感染率极低的国家，感染率为0.1%）的普遍艾滋病病毒产前筛查进行经济学评估，并与目前仅对高危群体女性进行检测的政策进行比较。
构建了一个成本效益分析模型。艾滋病病毒呈阳性新生儿和健康新生儿的预期寿命、直接医疗成本和效用权重均来自文献。使用第四代联合检测法对筛查进行评估。与以色列领先的艾滋病病毒专家讨论了结构不确定性。进行了单变量和多变量敏感性分析，以考虑模型参数的不确定性。
在当前政策下，每年约有2700名女性接受检测，其中27名女性被检测出艾滋病病毒呈阳性。采用普遍筛查时，每年将有171000名女性接受检测，其中37名被检测出艾滋病病毒呈阳性。该分析纳入了根据当前护理标准，垂直感染儿童预期寿命的增加情况。与目前仅针对高危群体的政策相比，在整个预期寿命期间，预计普遍筛查将多带来15个质量调整生命年，并节省177521美元。
尽管以色列普通人群中的艾滋病病毒感染率极低，但预计普遍产前艾滋病病毒筛查仍可节省成本。
