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Screening Women of Childbearing Age for Human Immunodeficiency Virus: A Model-Based Policy Analysis

Author

Listed:
  • Margaret L. Brandeau

    (Department of Industrial Engineering and Engineering Management, Stanford University, Stanford, California 94305)

  • Douglas K. Owens

    (Division of General Internal Medicine, Department of Medicine, Stanford University Medical School, Stanford, California 94305 and Department of Medicine, Department of Veterans Affairs Medical Center, Palo Alto, California 94304)

  • Carol H. Sox

    (Department of Community and Family Medicine, Dartmouth Medical School, Hanover, New Hampshire 03755)

  • Robert M. Wachter

    (Division of General Internal Medicine, San Francisco General Hospital, and Department of Medicine, University of California, San Francisco, California 94143)

Abstract

This paper analyzes the costs and benefits of screening women of childbearing age for HIV. The analysis is based on a dynamic compartmental model of the HIV epidemic that incorporates disease transmission and progression over time, behavioral changes, and effects of screening and associated counseling and education. The model allows one to consider not only effects on the screened women and their newborns, but also effects on the rest of the population. The analysis reveals that the primary benefit of screening programs targeted to women of childbearing age lies not in the prevention of HIV infection in their newborns but in the prevention of infection in their adult contacts. We find that screening medium and high risk women is likely to be cost-beneficial. Screening women regardless of risk group may also be cost-beneficial if screened positive women show relatively modest levels of behavioral change, but screening programs that reach primarily low risk women are not likely to be cost-beneficial. The results hold over a broad range of sensitivity analyses of important variables.

Suggested Citation

  • Margaret L. Brandeau & Douglas K. Owens & Carol H. Sox & Robert M. Wachter, 1993. "Screening Women of Childbearing Age for Human Immunodeficiency Virus: A Model-Based Policy Analysis," Management Science, INFORMS, vol. 39(1), pages 72-92, January.
    • Handle: RePEc:inm:ormnsc:v:39:y:1993:i:1:p:72-92
    DOI: 10.1287/mnsc.39.1.72
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    Citations

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    Cited by:

    1. Zheng Zhang & Brian T. Denton & Todd M. Morgan, 2022. "Optimization of active surveillance strategies for heterogeneous patients with prostate cancer," Production and Operations Management, Production and Operations Management Society, vol. 31(11), pages 4021-4037, November.
    2. Negar Darabi & Niyousha Hosseinichimeh, 2020. "System dynamics modeling in health and medicine: a systematic literature review," System Dynamics Review, System Dynamics Society, vol. 36(1), pages 29-73, January.
    3. James G. Kahn & Margaret L. Brandeau & John Dunn-Mortimer, 1998. "OR Modeling and AIDS Policy: From Theory to Practice," Interfaces, INFORMS, vol. 28(3), pages 3-22, June.
    4. Jingyu Zhang & Brian T. Denton & Hari Balasubramanian & Nilay D. Shah & Brant A. Inman, 2012. "Optimization of Prostate Biopsy Referral Decisions," Manufacturing & Service Operations Management, INFORMS, vol. 14(4), pages 529-547, October.
    5. Gregory S. Zaric & Margaret L. Brandeau & Paul G. Barnett, 2000. "Methadone Maintenance and HIV Prevention: A Cost-Effectiveness Analysis," Management Science, INFORMS, vol. 46(8), pages 1013-1031, August.
    6. Douglas K. Owens & Margaret L. Brandeau & Carol H. Sox, 1998. "Effect of Relapse to High-Risk Behavior on the Costs and Benefits of a Program to Screen Women for Human Immunodeficiency Virus," Interfaces, INFORMS, vol. 28(3), pages 52-74, June.
    7. Lasry, Arielle & Zaric, Gregory S. & Carter, Michael W., 2007. "Multi-level resource allocation for HIV prevention: A model for developing countries," European Journal of Operational Research, Elsevier, vol. 180(2), pages 786-799, July.

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