Cost-effectiveness of cesarean section delivery to prevent mother-to-child transmission of HIV-1

Michael T. Halpern, Jennifer S. Read, Dara A. Ganoczy, D. Robert Harris

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Objective: To evaluate costs and outcomes of cesarean section performed before onset of labor and before rupture of membranes (elective cesarean section) compared to vaginal delivery among HIV-infected women. Design: Cost-effectiveness and cost-benefit analysis. Participants and setting: Pregnant HIV-infected women in the US who refrain from breastfeeding. Intervention: Elective cesarean section versus vaginal delivery by antiretroviral therapy regimen. Main outcome measures: Pediatric HIV cases avoided, years of life saved, and direct medical costs for maternal interventions and pediatric HIV treatment. Results: Elective cesarean section (versus vaginal delivery) was cost-effective among women receiving zidovudine prophylaxis (US$1131 per case avoided, US$17 per year of life saved) and combination antiretroviral therapy (US$112 693 per case avoided, US$1697 per year of life saved), and cost saving among women receiving no antiretroviral therapy during pregnancy (benefit-cost ratio of 2.23). Although elective cesarean section remained cost-effective, results were sensitive to variations in vertical transmission rates and to pediatric HIV treatment costs. Population-based analyses indicated that elective cesarean section could prevent 239 pediatric HIV cases annually with a savings of over US$4 million. Conclusions: Elective cesarean section is a cost-effective intervention to prevent vertical transmission of HIV among women receiving various antiretroviral therapy regimens, who refrain from breastfeeding. (C) 2000 Lippincott Williams and Wilkins.

Original languageEnglish (US)
Pages (from-to)691-700
Number of pages10
Issue number6
StatePublished - 2000
Externally publishedYes


  • Analysis
  • Cost-effectiveness
  • Decision
  • Economic models
  • HIV
  • Prevention
  • Vertical transmission

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases


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