HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by CHEN, K. T. Articles by TUOMALA, R. E. Search for Related Content PubMed PubMed Citation Articles by CHEN, K. T. Articles by TUOMALA, R. E.

Cost-Effectiveness of Elective Cesarean Delivery in Human Immunodeficiency Virus–Infected Women

From the Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, and the Division of Sociomedical Sciences, Joseph L. Mailman School of Public Health of Columbia University, New York, New York.

Address reprint requests to: Katherine T. Chen, MD, MPH Department of Obstetrics, Gynecology, and Reproductive Biology Brigham and Women’s Hospital 75 Francis Street Boston, MA 02115 E-mail: kchen{at}partners.org

Objective: To evaluate the cost-effectiveness of an elective cesarean delivery strategy in human immunodeficiency virus (HIV)-infected women receiving zidovudine therapy to prevent perinatal transmission.

Methods: A decision-analysis model was constructed to compare two delivery strategies in HIV-infected women: usual care and recommendation for elective cesarean delivery. The model followed a hypothetical cohort of 7000 HIV-infected pregnant women in the United States who were receiving zidovudine therapy for 1 year. The third-party payer perspective was taken. Cost of delivery method with and without complications and lifetime medical care cost for pediatric HIV infection were considered. The main outcome measure was cases of perinatal HIV transmission prevented.

Results: Compared with the usual care strategy, the elective cesarean delivery strategy resulted in an additional 3486 cesarean deliveries each year, prevented 142 cases (52.4%) of perinatal HIV transmission, and resulted in incremental overall cost savings to society of $5.3 million per year ($37,284 saved per case of perinatal transmission prevented). With other estimates held constant, the elective cesarean delivery strategy would not be cost saving when the baseline perinatal HIV transmission rates were all reduced by 43.3%.

Conclusions: Elective cesarean delivery in HIV-infected women receiving zidovudine is one management strategy for prevention of perinatal HIV transmission and can be cost saving. However, if other strategies, such as use of combination antiretroviral therapy and/or measurement of viral load, result in at least 50% reduction of the baseline perinatal HIV transmission rates, elective cesarean delivery will not be cost saving.

This article has been cited by other articles:

				J. Hornberger, M. Holodniy, K. Robertus, M. Winnike, E. Gibson, and E. Verhulst A Systematic Review of Cost-Utility Analyses in HIV/AIDS: Implications for Public Policy Med Decis Making, December 1, 2007; 27(6): 789 - 821. [Abstract] [PDF]