Objective. To determine the cost-effectiveness of universal maternal HIV screening at time of delivery to decrease mother-to-child\ntransmission (MTCT), by comparing the cost and quality-adjusted life years (QALYs) of universal rapid HIV screening at time\nof delivery to two current standards of care for prenatal HIV screening in the United States. Study Design. We conducted a costeffectiveness\nanalysis to compare the cost and QALY of universal intrapartum rapid HIV screening with two current standards of\ncare: (I) opt-out rapid HIV testing limited to patients without previous third-trimester screening and (II) opt-out rapid HIV testing\nlimited to patients without any prenatal screening. We developed a decision-tree model and performed sensitivity analyses to\nestimate the impact of variances in QALY, estimated lifetime medical costs, HIV prevalence, and cumulative incidence. Results.The\nincremental cost-effectiveness ratio for universal screening was $7,973.45/QALY.The results remained robust to sensitivity analysis,\nexcept for annual cumulative incidence. In areas with an annual cumulative incidence rate of <0.02% for reproductive-age women,\nthe incremental cost-effectiveness ratio for the expanded program would exceed $89,926.94/QALY, approaching the commonly\napplied cost-effectiveness thresholds ($100,000/QALY). Conclusions. Intrapartumuniversal rapid HIV screening to decreaseMTCT\nappears cost-effective in populations with high HIV incidence in the United States
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