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A Cost-benefit Analysis

Margaret L. Brandeau, PhD; Douglas K. Owens, MD; Carol H. Sox, Engr; Robert M. Wachter, MD

Arch Intern Med. 1992;152(11):2229-2237.

Abstract
In light of the increasing problem of perinatal human immunodeficiency virus (HIV) transmission, the issue of screening women for HIV is receiving considerable attention. We analyzed the costs and benefits of screening women of childbearing age for HIV. The analysis was based on a dynamic model of the HIV epidemic that incorporated disease transmission and progression, behavioral changes, and effects of screening and counseling. We found that the primary benefit of screening programs targeted to women of childbearing age lies not in the prevention of HIV infection in their newborns but in the prevention of infection in their adult contacts. Because of this benefit, screening medium- and high-risk women is likely to be cost-beneficial over a wide range of assumptions about program cost and behavioral changes in response to screening.

(Arch Intern Med. 1992;152:2229-2237)

Author Affiliations
From the Department of Industrial Engineering and Engineering Management (Dr Brandeau) and Division of General Internal Medicine, Department of Medicine (Dr Owens), Stanford (Calif) University; Department of Veterans' Affairs Medical Center, Ambulatory Care, Palo Alto, Calif (Dr Owens); Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH (Ms Sox); and Division of General Internal Medicine, San Francisco (Calif) General Hospital, and Departments of Medicine and Epidemiology, University of California, San Francisco (Dr Wachter).

Footnotes
Accepted for publication April 21, 1992.

Reprint requests to Department of Industrial Engineering and Engineering Management, Stanford University, Stanford, CA 94305-4024 (Dr Brandeau).

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