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ELECTRONIC ARTICLE:
Lilly Cheng Immergluck, William L. Cull, Alan Schwartz, and Arthur S. Elstein
Cost-Effectiveness of Universal Compared With Voluntary Screening for Human Immunodeficiency Virus Among Pregnant Women in Chicago
Pediatrics 2000; 105: e54 [Abstract] [Full text] [PDF]
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[Read P3R] Questions for Dr. Immergluck, et al.
Corinna Haberland   (28 April 2000)

Questions for Dr. Immergluck, et al. 28 April 2000
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Corinna Haberland,
post-doctoral fellow
Stanford University

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Re: Questions for Dr. Immergluck, et al.

haber{at}healthpolicy.stanford.edu Corinna Haberland

Dear Dr. Immergluck and colleagues,

I recently read your article, "Cost-Effectiveness of Universal Compared With Voluntary Screening for Human Immunodeficiency Virus Among Pregnant Women in Chicago" with great interest. I noted two potential issues with the article's cost estimates, however, and was hoping for some clarification.

1. When estimating the savings from averting an HIV infection in neonates, the article did not specifically mention factoring in the costs of caring for a healthy child (the baseline cost of caring for a "perinatally HIV-infected child" was listed as $171,373.51, but there is no value listed for costs of a HIV-negative child). A case averted would have lifetime costs of usual medical care (at least). Were these costs accounted for and how were they calculated?

2. The article also did not mention factoring in the costs of earlier care and treatment for the newly diagnosed HIV-positive mothers. Some percentage of these women would have remained symptom free for several more years, and would not have been identified, potentially, until they developed signs of infection. This earlier treatment involves significant cost increases in their care (but also, potentially, significant quality of life improvements) and would potentially affect the cost-effectiveness calculations.

Were these issues factored into the calculations, and just not highlighted in the explanations, or, if not, why were they excluded? Thank you for your time.

Sincerely,

Corinna Haberland, MD

Fellow in Health Research and Policy

Stanford University

haber@healthpolicy.stanford.edu