Rapid HIV versus enzyme-linked immunosorbent assay screening in a low-risk Mexican American population presenting in labor: A cost-effectiveness analysis

• Published in: American journal of obstetrics and gynecology Vol. 193; no. 3; pp. 1280 - 1285
• Main Authors: Doyle, Nora M., Levison, Judy E., Gardner, Michael O.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01-09-2005; Elsevier
• Subjects: Anti-HIV Agents - therapeutic use; Biological and medical sciences; Blotting, Western; Cost-effectiveness; Decision Support Techniques; Delivery. Postpartum. Lactation; Enzyme-linked immunosorbent assay; Enzyme-Linked Immunosorbent Assay - economics; Female; Gynecology. Andrology. Obstetrics; HIV Infections - diagnosis; Human immunodeficiency virus; Human viral diseases; Humans; Immunoassay - methods; Infectious diseases; Labor, Obstetric; Low prevalence; Mass Screening - methods; Medical sciences; Mexican American; Mexican Americans; Point-of-Care Systems; Pregnancy; Pregnancy Complications, Infectious - diagnosis; Rapid test; Sensitivity and Specificity; Texas; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Zidovudine - therapeutic use; Texas; Pregnancy; Rapid test; Mexican American; Human immunodeficiency virus; Cost-effectiveness; Enzyme-linked immunosorbent assay; Low prevalence; Human immunodeficiency virus Pregnancy Rapid test Cost-effectiveness Enzyme-linked immunosorbent assay Mexican American Low prevalence; Prevalence; Latinamerican; Labor; Epidemiology; Low risk; Female; Cost efficiency analysis; Human; Immunopathology; Gynecology; Retroviridae; Exploration; AIDS; Medical screening; Immune deficiency; Lentivirus; Obstetrics; Infection; Virus; Viral disease; Health economy; Delivery; Cost analysis; ELISA assay; Comparative study
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2005.07.001

Mother-to-child transmission of human immunodeficiency virus is the most common cause of pediatric human immunodeficiency virus in the United States; the Centers for Disease Control and Prevention recommendations endorse rapid human immunodeficiency virus testing for women with unknown viral status to quicken antiretroviral therapy. We compared the cost-effectiveness of Oraquick (Orasure Technologies, Bethlehem, Pa) rapid testing versus enzyme-linked immunosorbent assay testing for a low-risk population of Mexican American women who are in labor.
Using decision analysis techniques, we tested 2 strategies: (1) testing with enzyme-linked immunosorbent assay that was confirmed by Western blot and (2) testing with Oraquick rapid testing that was confirmed by Western blot. All seropositive parturients received zidovudine treatment in labor. The baseline assumptions were the incidence of human immunodeficiency virus in Mexican American mothers (0.05%), mother-to-child transmission with no treatment (25%), with treatment in labor (10%), sensitivity of enzyme-linked immunosorbent assay (98%), positive predictive value of enzyme-linked immunosorbent assay (10%), sensitivity/specificity of Oraquick rapid testing (99%/100%), positive predictive value of Oraquick rapid testing (83%-100%), sensitivity/specificity of Western blot (97%/99%), costs (enzyme-linked immunosorbent assay [$5], Oraquick rapid testing [$15], Western blot [$25], zidovudine treatment [$76] for 12 hours labor, neonatal treatment [$2.50], lifetime treatment of human immunodeficiency virus–affected child [$194,250]). Sensitivity analyses were done over a wide range of assumptions that included the costs of tests, the sensitivity of Oraquick rapid testing, the positive predictive value of enzyme-linked immunosorbent assay and Oraquick rapid testing, and the costs of treatments.
Oraquick rapid testing was the preferred strategy at $98 spent per human immunodeficiency virus–negative child versus $491 for enzyme-linked immunosorbent assay testing. Much of the cost of the enzyme-linked immunosorbent assay strategy was due to the treatment of women and infants with false-positive tests. Sensitivity analysis over test costs, test sensitivity, and other variables found the analysis results to be robust. Threshold analysis revealed that, if the cost remained <$409.90, Oraquick rapid testing was the dominant test.
In a low prevalence population, the universal use of Oraquick rapid testing is cost-effective because of the low rate of false-positive results, thus preventing the emotional and economic costs of unnecessary treatment for human immunodeficiency virus to the new mother and her family.