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AIDS. 2000 Apr 14;14(6):691-700.

Cost-effectiveness of cesarean section delivery to prevent mother-to-child transmission of HIV-1.

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1
MEDTAP International, Inc., Rockville, Maryland, USA.

Abstract

OBJECTIVE:

To evaluate costs and outcomes of cesarean section performed before onset of labor and before rupture of membranes (elective cesarean section) compared to vaginal delivery among HIV-infected women.

DESIGN:

Cost-effectiveness and cost-benefit analysis.

PARTICIPANTS AND SETTING:

Pregnant HIV-infected women in the US who refrain from breastfeeding.

INTERVENTION:

Elective cesarean section versus vaginal delivery by antiretroviral therapy regimen.

MAIN OUTCOME MEASURES:

Pediatric HIV cases avoided, years of life saved, and direct medical costs for maternal interventions and pediatric HIV treatment.

RESULTS:

Elective cesarean section (versus vaginal delivery) was cost-effective among women receiving zidovudine prophylaxis (US$1131 per case avoided, US$17 per year of life saved) and combination antiretroviral therapy (US$112693 per case avoided, US$1697 per year of life saved), and cost saving among women receiving no antiretroviral therapy during pregnancy (benefit-cost ratio of 2.23). Although elective cesarean section remained cost-effective, results were sensitive to variations in vertical transmission rates and to pediatric HIV treatment costs. Population-based analyses indicated that elective cesarean section could prevent 239 pediatric HIV cases annually with a savings of over US$4 million.

CONCLUSIONS:

Elective cesarean section is a cost-effective intervention to prevent vertical transmission of HIV among women receiving various antiretroviral therapy regimens, who refrain from breastfeeding.

[Indexed for MEDLINE]

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