Universal Rapid Human Immunodeficiency Virus Screening at Delivery: A Cost-Effectiveness Analysis

Table 2

Input parameters.

Variable	Value	Reference
Probability variables
Prevalence of HIV at initial test	1.9%	[17]^†
Cumulative incidence of HIV/year^α	0.087%	[17]^†
Sensitivity of prenatal HIV test	100.0%	[18]
Specificity of prenatal HIV test	99.9%	[18]
Initial HIV test compliance	90.4%	[19]
3rd-trimester HIV test compliance	80.0%	[19]
Sensitivity of rapid test	99.7%	Package
Specificity of rapid test	99.9%	Package
Cesarean delivery rate	32.7%	MWHC,
Probability of vertical transmission for a vaginal delivery (without maternal prophylaxis (MP) or neonatal prophylaxis (NP))	25.5%	[12]
Probability of vertical transmission for a cesarean delivery before active labor or rupture of membranes (without maternal prophylaxis or neonatal prophylaxis)	10.4%	[10]
Probability of vertical transmission with maternal and neonatal prophylaxis	2.8%	[20]
Probability of vertical transmission with only neonatal prophylaxis	5.7%	[20]
Cost variables
Cost of rapid test		Medicare Clinical Diagnostic Laboratory Fee
Cost of maternal prophylaxis (with zidovudine (AZT))
Cost of neonatal prophylaxis (AZT + Nevirapine (NVP) per US guidelines)
Cost of usual care and cesarean delivery		Medicare physician fee schedule and
Cost of usual care and vaginal delivery		Medicare physician fee schedule and
Lifetime additional medical cost for PAH in present value		[21]
Other variables
QALY saved if one case of MTCT was prevented in present value		[21]

were based on women between ages of 14 and 45 at the end of 2012, obtained/derived from Department of Health, Government of the District of Columbia. were provided by the Women’s and Infants’ Services Department of MedStar Washington Hospital Center in 2015. HIV 1/2 STAT-PAK package insert. adequate treatment of 2 mg/kg loading dose, + 1 mg/kg/hr times 3 hrs prior to delivery, and ideal body weight of a 64-inch female + 25 lb weight gain during pregnancy = 155 lb or 70 kg. Published cost of AZT is 35.03 for 200 mg (20 mL of 10 mg/mL). Cost of AZT based on 70 kg woman for adequate prophylaxis: (140 mg loading dose + 70 mg/hr × 3 hrs = 350 mg) = 350 mg × $35.03/200 mg = $61.30. data obtained from the Fisher Scientific Website https://www.fishersci.com/us/en/catalog/search/products?keyword=4th+generation+rapid+hiv+test&nav. to 2015 dollars. value was derived from 28 minus 9 from the reference. A 3% discount rate has been applied to indicate a present value. cumulative incidence, or incidence proportion, is the proportion of a initially disease-free population that developed disease during a specified period of time, http://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson3/section2.html. With the annual cumulative incidence available, we derived 12 weeks, 14 weeks, and 26 weeks of cumulative incidences needed in our model by assuming no temporal trend of the risk. of vaginal delivery and Cesarean delivery were the combination of hospital costs and physician costs. The hospital costs were obtained based on the DRG codes and the division, using HCUPnet online tool http://hcupnet.ahrq.gov/. Costs of physician services were based on the Medicare physician fee schedule (https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/) with associated HCPCS codes and the location.