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.