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

Publication

Author(s):

Tweya H, 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: Mathematical modelling study.

Pub Date:

Mar 1 2016

Pub Region(s):

Southern Africa

Journal:

Title: 
AIDS
Link: 
http://ovidsp.tx.ovid.com/sp-3.18.0b/ovidweb.cgi?WebLinkFrameset=1&S=FHIGFPMFMKDDMEGBNCJKIAIBEFBHAA00&returnUrl=ovidweb.cgi%3fMain%2bSearch%2bPage%3d1%26S%3dFHIGFPMFMKDDMEGBNCJKIAIBEFBHAA00&directlink=http%3a%2f%2fgraphics.tx.ovid.com%2fovftpdfs%2fFPDDNCI

PubMed: 26691682

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 to 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 parameterised the model with data from the literature and by analysing programmatic data. We compared total costs of ante-natal and post-natal care, and lifetime costs and disability-adjusted life-years (DALYs) 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 to 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:

Tweya H, Keiser O, Haas AD, Tenthani L, Phiri S, Egger M, Estill J. Comparative cost-effectiveness of Option B+ for prevention of mother to child transmission of HIV in Malawi: Mathematical modelling study. AIDS. 2015 Dec 18. [Epub ahead of print] PubMed PMID: 26691682.