OBJECTIVES: We sought to determine the health and economic consequences of
voluntary rapid human immunodeficiency testing during labor for women who h
ave not received adequate prenatal care.
STUDY DESIGN: A decision-tree model was used to assess the number of pediat
ric human immunodeficiency virus cases that would be averted if women who w
ere unable to determine their human immunodeficiency virus serostatus anten
atally were offered an intrapartum rapid human immunodeficiency virus test.
Medical costs associated with the introduction of this policy were also de
termined. Probability and cost estimates entered into the model are based o
n data in the published literature.
RESULTS: Under the base-case assumptions, a policy of intrapartum voluntary
rapid human immunodeficiency virus testing decreases the number of cases o
f perinatal human immunodeficiency virus from 407 to 339 per 100,000 women
without adequate prenatal care per year, with a corresponding cost savings
of $6 million. Sensitivity analysis demonstrates that these cost savings ar
e maintained across a wide range of assumptions and that even conservative
scenarios still result in a cost-effective policy.
CONCLUSIONS: In the absence of adequate prenatal care, a voluntary rapid hu
man immunodeficiency virus test not only allows patients to fully explore t
heir options with regard to testing and treatment but also has the potentia
l to provide significant health benefits to women and children and economic
benefits to the medical system.