Myers E R, Thompson J W, Simpson K
Department of Obstetrics and Gynecology, Beth Israel-Deaconess Medical Center, Boston, Massachusetts, USA.
Obstet Gynecol. 1998 Feb;91(2):174-81. doi: 10.1016/s0029-7844(97)00629-7.
To determine the cost-effectiveness of mandatory screening for human immunodeficiency virus (HIV) in pregnancy compared with that of voluntary screening under varying assumptions about patient behavior.
Using a health care system perspective, a decision-analysis model was constructed to estimate the outcomes and costs of the two strategies. Average and incremental cost-effectiveness ratios were calculated for each strategy. Sensitivity analyses were performed to test the effects of different values on the results of the simulation. In particular, we examined the potential effects of changes in patient behavior resulting from mandatory screening on our estimates of cost-effectiveness.
At a prevalence of 170 per 100,000, average costs per case prevented were $255,158 and $367,998 for mandatory and voluntary screening, respectively. The incremental cost-effectiveness of mandatory compared with voluntary screening was $29,478. These values decreased as prevalence of HIV increased, or as the estimated lifetime cost of pediatric HIV infection increased: above an estimated cost for pediatric HIV of $129,250, mandatory screening was less expensive and more effective than voluntary screening. Assumptions about patient behavior affected these results: a 40% reduction in zidovudine acceptance in women identified only through mandatory screening increased the incremental cost-effectiveness to $112,434. The impact of behavior increased as the prevalence of HIV increased.
Mandatory screening will prevent more cases of pediatric AIDS, but at a somewhat higher cost than voluntary screening under baseline assumptions. The cost-effectiveness of mandatory screening will be influenced by patient behavior, especially acceptance of zidovudine treatment among women who would have refused voluntary screening.
在关于患者行为的不同假设下，确定孕期强制筛查人类免疫缺陷病毒（HIV）与自愿筛查相比的成本效益。
从医疗保健系统的角度出发，构建了一个决策分析模型来估计这两种策略的结果和成本。计算了每种策略的平均成本效益比和增量成本效益比。进行了敏感性分析，以测试不同值对模拟结果的影响。特别是，我们研究了强制筛查导致的患者行为变化对我们成本效益估计的潜在影响。
在每10万人中有170例的患病率下，强制筛查和自愿筛查每预防一例的平均成本分别为255,158美元和367,998美元。强制筛查与自愿筛查相比的增量成本效益为29,478美元。随着HIV患病率的增加或儿童HIV感染估计终身成本的增加，这些值会降低：在儿童HIV估计成本高于129,250美元时，强制筛查比自愿筛查成本更低且更有效。关于患者行为的假设影响了这些结果：仅通过强制筛查发现的女性接受齐多夫定治疗的比例降低40%，会使增量成本效益增加到112,434美元。随着HIV患病率的增加，行为的影响也会增加。
强制筛查将预防更多的儿童艾滋病病例，但在基线假设下，成本比自愿筛查略高。强制筛查的成本效益将受到患者行为的影响，特别是在那些原本会拒绝自愿筛查的女性中接受齐多夫定治疗的情况。
