EDITORIAL COMMENT TheeconomicprofileofantenatalHIVtesting: pharmaceuticalandmethodologicalconsiderations MaartenJ.Postma,EduardJ.Beck a ,HermanG.Sprenger b ,and LolkjeT.W.deJong-vandenBerg AIDS 2003, 17:755–757 Keywords:antenatalHIVtesting,economicevaluation,adversedrugreactions, pharmaco-economicguidelines,discounting In this issue, Bramley et al. demonstrate that universal antenatal HIV-testing and appropriate follow-up has an economic profile justifying implementation in New Zealand’s health care system [1]. Estimated cost effec- tiveness of this intervention – including anti-retroviral therapy (ART) to reduce perinatal transmission of HIV in those found infected – compared favourably with other health care interventions such as dialysis for end- stage renal disease and mammography screening [1]. Furthermore, estimated cost effectiveness of US$7500 per life-year gained is below those few thresholds suggested to date in the international literature ($US 50 000 and $Can 20 000) [2,3]. Bramley et al. devel- oped a simulation model incorporating costs (testing and counselling, anti-retroviral combination therapies for mother and baby, and excess costs of Cesarean section over natural delivery), benefits (averted lifetime health care costs for HIV-infected babies) and health gains (life-years gained for mother and baby). By applying an incremental cost effectiveness design, an- tenatal HIV-testing in New Zealand was estimated to cost an additional annual $US 300 000, detect five HIV-exposed babies nationwide and avoid one perina- tal transmission per year [1]. Cost effectiveness analyses relate differences between monetary costs and benefits (net costs) of an interven- tion to its clinical outcome, such as life-years gained. Cost effectiveness is one of two most frequently used types of economic evaluation of efficiency in health care provision, the other being cost-utility analysis [4]. Whereas cost effectiveness analysis expresses its out- comes in biomedical terms – such as, life-years gained or averted HIV infections in babies – cost-utility ana- lyses extend the elaboration with quality-of-life im- pacts. The typical integrated outcome of a cost-utility analysis is net cost per quality-adjusted life-year or disability-adjusted life-year (DALY) gained. Previously, Ades et al. reviewed the literature on economic evaluation of antenatal HIV testing [5]. Of 13 studies identified, one was a cost-utility analysis and the remainder were cost effectiveness analyses. Mar- seille et al. estimated cost-utility for one dose of Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Seealsop741 From the Department of Social Pharmacy, Pharmaco-epidemiology and Pharmacotherapy, Groningen University Institute for Drug Exploration/University of Groningen Research Institute of Pharmacy (GUIDE/GRIP), Groningen, The Netherlands, the a Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Que ´bec, Montreal, Canada, and the b Department of Internal Medicine, University Hospital Groningen, Groningen, The Netherlands. Correspondence to M. J. Postma, GUIDE/GRIP, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands. Received: 10 October 2002; accepted: 23 October 2002. DOI: 10.1097/01.aids.0000050815.06065.6a ISSN0269-9370 & 2003LippincottWilliams&Wilkins 755