Universal antenatal human immunodeficiency virus (HIV) testing programme is cost-effective despite a low HIV prevalence in Hong Kong

PM Lee, KH Wong
Red Ribbon Centre, Public Health Services Branch, Centre for Health Protection, Department of Health, Hong Kong

OBJECTIVE. To evaluate the cost-effectiveness of universal antenatal human immunodeficiency virus (HIV) testing in Hong Kong.

DESIGN. Cost-effectiveness analysis from the health care provider's perspective.

SETTING. Public antenatal clinics in Hong Kong.

PARTICIPANTS. All pregnant women who gave birth in Hong Kong during the inclusive period 1 September 2001 and 31 December 2004.

MAIN OUTCOME MEASURES. The primary endpoints were (i) the cost per HIV infection avoided and (ii) the cost per life-year gained.

RESULTS. From 2001 to 2004, a total of 160 878 deliveries were recorded in Hong Kong; and 75% of the corresponding women had HIV-testing before delivery. In all, 28 women tested HIV-positive and gave birth to 15 babies, one of which was HIV-positive. The mother of the infected baby presented late in labour, without her HIV status being diagnosed and thus missed the opportunity for prompt intervention. Assuming a natural transmission rate of 25%, it was estimated that six out of seven anticipated HIV infections among the newborns had been avoided. The cost for implementation of the programme for the first 3 years was HKD12 227 988. Hence, the average costs per HIV infection averted and per discounted life-year gained were HKD2 037 998 and HKD79 099, respectively. Sensitivity analysis showed that both the coverage and the loss-to-follow-up rate were the major determinants of the cost-effectiveness of the universal antenatal testing programme in Hong Kong.

CONCLUSION. The universal antenatal testing programme in Hong Kong is largely efficient. In view of the low prevalence of HIV infection, high rates of HIV testing and uptake of antiretroviral prophylaxis are crucial to the success of the programme.

Hong Kong Med J 2007;13:199-207

Key words: Cost-benefit analysis; Disease transmission, vertical; HIV infections; Mass screening; Quality-adjusted life years