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

AIDS. 2000 Apr 14;14(6):691-700. doi: 10.1097/00002030-200004140-00008.


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.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anti-HIV Agents / therapeutic use
  • Cesarean Section / economics*
  • Cost-Benefit Analysis
  • Decision Support Techniques
  • Delivery, Obstetric
  • Elective Surgical Procedures
  • Female
  • HIV Infections / drug therapy
  • HIV Infections / prevention & control
  • HIV Infections / transmission*
  • HIV-1* / physiology
  • Humans
  • Infant, Newborn
  • Infectious Disease Transmission, Vertical / prevention & control*
  • Models, Economic
  • Pregnancy
  • Pregnancy Complications, Infectious / drug therapy
  • Pregnancy Complications, Infectious / virology*
  • Zidovudine / therapeutic use


  • Anti-HIV Agents
  • Zidovudine