Article Text

  1. L Wilson1,
  2. L Hensic1,
  3. M Christenson1,
  4. M Pregenzer1,
  5. M Muskat2,
  6. D Wara2
  1. 1Department of Clinical Pharmacy, University of California, San Francisco, California, USA
  2. 2Department of Pediatric Immunology and Rheumatology, University of California, San Francisco, California, USA


Introduction An estimated 7000 infants are born to HIV+ mothers yearly. A 1994 study showed chemoprophylaxis with zidovudine reduced perinatal HIV transmission rate from 25.5% to 8.3%, representing a large potential cost savings.

Objective The purpose of this study is to compare the total cost of care for infants born into the pre-prophylaxis era (pre-1994) versus the current prophylaxis era (post-1994).

Methods A convenience sample of total costs of 47 paediatric patients born to HIV-infected mothers and treated at a specialty clinic from 1986 to 2007. The three main cost components in 1999 dollars include hospitalisations, outpatient visits and drugs.

Results The 9-year cost per HIV+ patient born in the pre-prophylaxis era was US$154 700 and US$106 149 for those born HIV+ in the prophylaxis era who did not receive prophylaxis (p>0.47). HIV– patient costs were approximately the same regardless of prophylaxis received (US$3625 vs US$2614). In the pre-prophylaxis era, drugs represented 50% and hospitalisations 41% of total costs of HIV+ children. In contrast, drugs accounted for 68% and hospitalisation only 20% of total costs for the prophylaxis era HIV+ child. Total annual care cost for children born into the pre-prophylaxis era was US$8.1M versus US$5.6M for those born into the current prophylaxis era, resulting in a US$2.5M annual cost savings.

Conclusion This is the first longitudinal look at HIV paediatric costs from the disease’s emergence, and provides an example of a success in the development of preventive medicine protocols. The prophylaxis era’s success in decreasing transmission rates is also reflected in the cost-savings shown here.

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