Objective To evaluate the cost-effectiveness and economic efficiency of integrated prevention of mother-to-child transmission (PMTCT) of HIV in four high-incidence counties. Methods Data of local resource investment and total cost for PMTCT in 4 counties in China from 2003 to 2006 were collected. Cost analysis and cost-effectiveness analysis were conducted. Average costs of a confirmed HIV case,a prevented case and a disability-adjusted life-year (DALY) saving were calculated. Results Average cost of identifying one HIV-infected mother was ￥5512. Costs of a pediatric HIV case prevention and per DALY saving were ￥46 747 and ￥1870 ( $231 ), respectively, based on the total cost perspective. Conclusion The cost of integrated prevention of mother-to-child transmission of HIV was low. The PMTCT program was economical efficiency.