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
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