Gorsky R D, Farnham P G, Straus W L, Caldwell B, Holtgrave D R, Simonds R J, Rogers M F, Guinan M E
Department of Health Management and Policy, University of New Hampshire, USA.
Public Health Rep. 1996 Jul-Aug;111(4):335-41.
To calculate the national costs of reducing perinatal transmission of human immunodeficiency virus through counseling and voluntary testing of pregnant women and zidovudine treatment of infected women and their infants, as recommended by the Public Health Service, and to compare these costs with the savings from reducing the number of pediatric infections.
The authors analyzed the estimated costs of the intervention and the estimated cost savings from reducing the number of pediatric infections. The outcome measures are the number of infections prevented by the intervention and the net cost (cost of intervention minus the savings from a reduced number of pediatric HIV infections). The base model assumed that intervention participation and outcomes would resemble those found in the AIDS Clinical Trials Group Protocol 076. Assumptions were varied regarding maternal seroprevalence, participation by HIV-infected women, the proportion of infected women who accepted and completed the treatment, and the efficacy of zidovudine to illustrate the effect of these assumptions on infections prevented and net cost.
Without the intervention, a perinatal HIV transmission rate of 25% would result in 1750 HIV-infected infants born annually in the United States, with lifetime medical-care costs estimated at $282 million. The cost of the intervention (counseling, testing, and zidovudine treatment) was estimated to be $ 67.6 million. In the base model, the intervention would prevent 656 pediatric HIV infections with a medical care cost saving of $105.6 million. The net cost saving of the intervention was $38.1 million.
Voluntary HIV screening of pregnant women and ziovudine treatment for infected women and their infants resulted in cost savings under most of the assumptions used in this analysis. These results strongly support implementation of the Public Health Service recommendations for this intervention.
按照公共卫生服务机构的建议，计算通过对孕妇进行咨询和自愿检测以及对感染妇女及其婴儿进行齐多夫定治疗来降低人类免疫缺陷病毒围产期传播的全国成本，并将这些成本与减少儿童感染数量所节省的费用进行比较。
作者分析了干预措施的估计成本以及减少儿童感染数量所估计节省的成本。结果指标是干预措施预防的感染数量和净成本（干预成本减去因儿童艾滋病毒感染数量减少而节省的费用）。基础模型假设干预措施的参与情况和结果与艾滋病临床试验组方案076中的情况相似。对孕产妇血清阳性率、艾滋病毒感染妇女的参与情况、接受并完成治疗的感染妇女比例以及齐多夫定的疗效等假设进行了变化，以说明这些假设对预防感染和净成本的影响。
若不采取干预措施，美国每年25%的围产期艾滋病毒传播率将导致1750名婴儿感染艾滋病毒，终生医疗护理成本估计为2.82亿美元。干预措施（咨询、检测和齐多夫定治疗）的成本估计为6760万美元。在基础模型中，干预措施将预防656例儿童艾滋病毒感染，节省医疗护理成本1.056亿美元。干预措施的净成本节省为3810万美元。
对孕妇进行艾滋病毒自愿筛查以及对感染妇女及其婴儿进行齐多夫定治疗，在本分析所采用的大多数假设下都能节省成本。这些结果有力地支持实施公共卫生服务机构针对该干预措施的建议。
