Human immunodeficiency virus retesting during pregnancy: costs and effectiveness in preventing perinatal transmission

Obstet Gynecol. 2003 Oct;102(4):782-90. doi: 10.1016/s0029-7844(03)00624-0.


Objective: To estimate the incremental societal costs and effectiveness of a second human immunodeficiency virus (HIV) antibody test during the third trimester of pregnancy compared with no second test.

Methods: We used a decision tree in this cost-effectiveness analysis to model outcomes among pregnant women in high-risk communities and nationwide who received an initial, negative HIV antibody test during the first trimester. The main outcome measure was discounted costs per year of infant life saved.

Results: In high-risk communities with estimated HIV incidence of 6.2 per 1000 person-years, a second HIV test compared with no second test would detect 192 infections in women, prevent approximately 37 infant infections, and save 655 infant life-years per 100,000 women tested. Net savings would be 5.2 million US dollars. Applied to an estimated national incidence of.17 per 1000 person-years, a second test would detect 5.3 infections in women, prevent 1.3 infant infections, and save 23.3 infant life-years per 100,000 women tested. Net costs would be 1.06 million US dollars, or 45,708 US dollars for each year of infant life saved. A second test would result in net savings in populations with HIV incidence of 1.2 per 1000 person-years or higher.

Conclusion: Health care providers serving women in communities with an HIV incidence of 1 per 1000 person-years or higher should strongly consider implementing a second voluntary universal HIV test during the third trimester. Providers serving lower-risk communities should pilot second testing to assess community-specific costs.

MeSH terms

  • Adult
  • Cost-Benefit Analysis
  • Decision Support Techniques
  • Female
  • HIV Antibodies / analysis
  • HIV Infections / diagnosis
  • HIV Infections / economics*
  • HIV Infections / epidemiology
  • HIV Infections / prevention & control*
  • HIV-1 / immunology
  • Humans
  • Incidence
  • Pregnancy
  • Pregnancy Complications, Infectious / diagnosis
  • Pregnancy Complications, Infectious / economics*
  • Pregnancy Complications, Infectious / epidemiology
  • Pregnancy Complications, Infectious / prevention & control*
  • Pregnancy Outcome
  • Pregnancy Trimester, First
  • Pregnancy Trimester, Third
  • Prenatal Care / economics*
  • United States / epidemiology


  • HIV Antibodies