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

Publication

Author(s):

Tweya H1, Keiser O, Haas AD, Tenthani L, Phiri S, Egger M, Estill J

Pub Title:

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

Pub Date:

Mar 27 2016

Pub Region(s):

Southern Africa

Journal:

Title: 
AIDS
Link: 
http://tinyurl.com/hft3p2x

PubMed: 26691682
Pub PDF:

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.

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Citation:

AIDS. 2016 Mar 27;30(6):953-62. doi: 10.1097/QAD.0000000000001009. Comparative cost-effectiveness of Option B+ for prevention of mother-to-child transmission of HIV in Malawi. Tweya H1, Keiser O, Haas AD, Tenthani L, Phiri S, Egger M, Estill J.