Cost-effectiveness estimates for antenatal HIV testing in the Netherlands

This paper provides an estimation of the lifetime healthcare cost of HIV-infected children and an update of the cost-effectiveness of universal HIV-screening of pregnant women in Amsterdam (The Netherlands). During 2003–2005, we collected data concerning the prevalence of newly diagnosed HIV-infected pregnant women in Amsterdam. Also, data on resource utilization and HAART regimen for HIV-infected children was gathered from a national registry. Using Kaplan-Meier survival analysis, we estimated the life-expectancy of a vertically HIV-infected child at 19 years, with the corresponding lifetime healthcare costs of €179,974. HIV-screening of pregnant women could prevent 2.4 HIV transmissions annually in Amsterdam, based on an estimated prevalence of nine yet undiagnosed HIV-positive pregnant women per 10,000 pregnancies. We show that universal HIV screening during pregnancy generates significant net cost savings and health benefits in most situations. Universal antenatal HIV screening is justified in Amsterdam from a health-economic point of view.

[1]  M. Postma,et al.  Enhanced decision support for policy makers using a web interface to health-economic models--illustrated with a cost-effectiveness analysis of nation-wide infant vaccination with the 7-valent pneumococcal conjugate vaccine in the Netherlands. , 2007, Vaccine.

[2]  P. Elferink-Stinkens,et al.  Trends in obstetric interventions in the Dutch obstetrical care system in the period 1993-2002. , 2007, European journal of obstetrics, gynecology, and reproductive biology.

[3]  L. Mofenson,et al.  Effect of perinatal antiretroviral drug exposure on hematologic values in HIV-uninfected children: An analysis of the women and infants transmission study. , 2006, The Journal of infectious diseases.

[4]  M. Muñoz-Fernández,et al.  Clinical outcomes improve with highly active antiretroviral therapy in vertically HIV type-1-infected children. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[5]  G. Marks,et al.  Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA , 2006, AIDS.

[6]  C. Brennan,et al.  Performance evaluation of three automated human immunodeficiency virus antigen-antibody combination immunoassays. , 2006, Journal of virological methods.

[7]  Jerome H. Carter,et al.  Distribution of health care expenditures for HIV-infected patients. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[8]  Jill Clark,et al.  Updated Estimates of Healthcare Utilization and Costs Among Perinatally HIV-Infected Children , 2006, Journal of acquired immune deficiency syndromes.

[9]  M. Weinstein,et al.  Should resistance testing be performed for treatment-naive HIV-infected patients? A cost-effectiveness analysis. , 2005, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[10]  T. Kuijpers,et al.  Haematological parameters of HIV‐1‐uninfected infants born to HIV‐1‐infected mothers , 2005, Acta paediatrica.

[11]  Andrew S. Coco,et al.  The Cost-Effectiveness of Expanded Testing for Primary HIV Infection , 2005, The Annals of Family Medicine.

[12]  M. Newell,et al.  Maternal and infant factors and lymphocyte, CD4 and CD8 cell counts in uninfected children of HIV-1-infected mothers , 2005, AIDS.

[13]  J. Dieleman,et al.  Nelfinavir and nevirapine side effects during pregnancy , 2005, AIDS.

[14]  S. Resch,et al.  Cost-Effectiveness of HIV Screening for Incarcerated Pregnant Women , 2005, Journal of acquired immune deficiency syndromes.

[15]  M. Newell,et al.  Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy. , 2005, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[16]  H. D. de Melker,et al.  Economic evaluation of meningococcal serogroup C conjugate vaccination programmes in The Netherlands and its impact on decision-making. , 2004, Vaccine.

[17]  T. Kuijpers,et al.  Levels and patterns of neutrophil cell counts over the first 8 years of life in children of HIV-1-infected mothers , 2004, AIDS.

[18]  W. Encinosa,et al.  Antiretroviral therapy and health care utilization: a study of privately insured men and women with HIV disease. , 2004, Health services research.

[19]  J. Kaldor,et al.  Would universal antenatal screening for HIV infection be cost-effective in a setting of very low prevalence? Modelling the data for Australia. , 2004, The Journal of infectious diseases.

[20]  N. Horton,et al.  Assessing missed opportunities for HIV testing in medical settings , 2004, Journal of general internal medicine.

[21]  J. Mrus,et al.  Cost-Effectiveness of Interventions to Reduce Vertical HIV Transmission from Pregnant Women Who Have Not Received Prenatal Care , 2004, Medical decision making : an international journal of the Society for Medical Decision Making.

[22]  U. Siebert,et al.  Cost Effectiveness Analysis of Routine Use of Genotypic Antiretroviral Resistance Testing after Failure of Antiretroviral Treatment for HIV , 2004, Antiviral therapy.

[23]  M. Sharland,et al.  Decline in mortality, AIDS, and hospital admissions in perinatally HIV-1 infected children in the United Kingdom and Ireland , 2003, BMJ : British Medical Journal.

[24]  C. Guihenneuc‐Jouyaux,et al.  Perinatal antiretroviral treatment and hematopoiesis in HIV-uninfected infants , 2003, AIDS.

[25]  N. Graves,et al.  The cost effectiveness of universal antenatal screening for HIV in New Zealand , 2003, AIDS.

[26]  L. Hurley,et al.  Review of Medical Encounters in the 5 Years Before a Diagnosis of HIV-1 Infection: Implications for Early Detection , 2003, Journal of acquired immune deficiency syndromes.

[27]  M. Nolan,et al.  A review of clinical trials to prevent mother-to-child HIV-1 transmission in Africa and inform rational intervention strategies , 2002, AIDS.

[28]  R. de Groot,et al.  [Reduction of vertical transmission by means of perinatal prophylaxis in the case of children exposed to HIV-1 and born in the Netherlands during the period 1995-1999]. , 2002, Nederlandsch tijdschrift voor geneeskunde.

[29]  Hirasing Ra,et al.  [Epidemiological characteristics of reported HIV-1 infection in children in the Netherlands, 1998-2000: vertical transmission via parents from countries with a generalised epidemic]. , 2002 .

[30]  C. Giaquinto,et al.  Pregnancy and HIV infection: a European consensus on management: Executive summary , 2002, AIDS.

[31]  L. Mofenson,et al.  Combination Antiretroviral Strategies for the Treatment of Pregnant HIV‐1‐Infected Women and Prevention of Perinatal HIV‐1 Transmission , 2002, Journal of acquired immune deficiency syndromes.

[32]  W. Hop,et al.  Results of 2 years of treatment with protease-inhibitor--containing antiretroviral therapy in dutch children infected with human immunodeficiency virus type 1. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[33]  Ed Sussman.  National HIV Prevention conference, Atlanta. , 2002, AIDS.

[34]  M. Postma,et al.  Cost-effectiveness of HIV screening of patients attending clinics for sexually transmitted diseases in Amsterdam , 2001, AIDS.

[35]  A. Berrebi,et al.  Lamivudine-zidovudine combination for prevention of maternal-infant transmission of HIV-1. , 2001, JAMA.

[36]  M. Postma,et al.  [Pharmaco-economic evaluation of mandatory HIV-screening in pregnancy; a cost-efficacy analysis in Amsterdam]. , 2000, Nederlands tijdschrift voor geneeskunde.

[37]  A. Elstein,et al.  Cost-Effectiveness of Universal Compared With Voluntary Screening for Human Immunodeficiency Virus Among Pregnant Women in Chicago , 2000, Pediatrics.

[38]  M. Fowler,et al.  Prevention of mother-to-child HIV transmission in resource-poor countries: translating research into policy and practice. , 2000, JAMA.

[39]  M. Postma,et al.  Universal HIV screening of pregnant women in England: cost effectiveness analysis , 1999, BMJ.

[40]  Casparie Af,et al.  Guidelines and costs , 1998 .

[41]  Pecora Pg.  Nelfinavir and nevirapine. , 1998 .

[42]  C. Boucher,et al.  Overshoot of HIV‐1 viraemia after early discontinuation of antiretroviral treatment , 1997, AIDS.

[43]  J. Huisman.  The Netherlands , 1996, The Lancet.

[44]  R. Hirasing,et al.  Epidemiologische kenmerken van gemelde HIV-1 infectie bij kinderen in Nederland, 1998-2000: verticale transmissie door ouders uit gebieden met een gegeneraliseerde epidemie. , 2002 .

[45]  M. Simoons,et al.  [Guidelines and costs]. , 1998, Nederlands tijdschrift voor geneeskunde.

[46]  P. Pecora.  Nelfinavir and nevirapine. , 1998, Journal of the American Pharmacists Association.

[47]  S. Wiktor,et al.  Prevention of mother-to-child transmission of HIV-1 in Africa. , 1997, AIDS.

[48]  C. Giaquinto,et al.  Rates of mother-to-child transmission of HIV-1 in Africa, America, and Europe: results from 13 perinatal studies. The Working Group on Mother-To-Child Transmission of HIV. , 1995, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.