Comparative cost-effectiveness of Option B+ for prevention of mother-to-child transmission of HIV in Malawi.

Tweya, Hannock; Keiser, Olivia; Haas, Andreas D; Tenthani, Lyson Nemoni; Phiri, Sam; Egger, Matthias; Estill, Janne (2016). Comparative cost-effectiveness of Option B+ for prevention of mother-to-child transmission of HIV in Malawi. AIDS, 30(6), pp. 953-962. Lippincott Williams & Wilkins 10.1097/QAD.0000000000001009

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OBJECTIVE To estimate the cost-effectiveness of prevention of mother-to-child transmission (MTCT) of HIV with lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women ('Option B+') compared with ART during pregnancy or breastfeeding only unless clinically indicated ('Option B'). DESIGN Mathematical modelling study of first and second pregnancy, informed by data from the Malawi Option B+ programme. METHODS Individual-based simulation model. We simulated cohorts of 10 000 women and their infants during two subsequent pregnancies, including the breastfeeding period, with either Option B+ or B. We parameterized the model with data from the literature and by analysing programmatic data. We compared total costs of antenatal and postnatal care, and lifetime costs and disability-adjusted life-years of the infected infants between Option B+ and Option B. RESULTS During the first pregnancy, 15% of the infants born to HIV-infected mothers acquired the infection. With Option B+, 39% of the women were on ART at the beginning of the second pregnancy, compared with 18% with Option B. For second pregnancies, the rates MTCT were 11.3% with Option B+ and 12.3% with Option B. The incremental cost-effectiveness ratio comparing the two options ranged between about US$ 500 and US$ 1300 per DALY averted. CONCLUSION Option B+ prevents more vertical transmissions of HIV than Option B, mainly because more women are already on ART at the beginning of the next pregnancy. Option B+ is a cost-effective strategy for PMTCT if the total future costs and lost lifetime of the infected infants are taken into account.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

Graduate School:

Graduate School for Cellular and Biomedical Sciences (GCB)
Graduate School for Health Sciences (GHS)

UniBE Contributor:

Keiser, Olivia; Haas, Andreas; Tenthani, Lyson Nemoni; Egger, Matthias and Estill, Janne Anton Markus

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0269-9370

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

21 Apr 2016 09:42

Last Modified:

13 Sep 2017 09:30

Publisher DOI:

10.1097/QAD.0000000000001009

PubMed ID:

26691682

BORIS DOI:

10.7892/boris.81315

URI:

https://boris.unibe.ch/id/eprint/81315

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