Document Detail


Cost-effectiveness of World Health Organization 2010 guidelines for prevention of mother-to-child HIV transmission in Zimbabwe.
MedLine Citation:
PMID:  23204035     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In 2010, the World Health Organization (WHO) released revised guidelines for prevention of mother-to-child human immunodeficiency virus (HIV) transmission (PMTCT). We projected clinical impacts, costs, and cost-effectiveness of WHO-recommended PMTCT strategies in Zimbabwe.
METHODS: We used Zimbabwean data in a validated computer model to simulate a cohort of pregnant, HIV-infected women (mean age, 24 years; mean CD4 count, 451 cells/µL; subsequent 18 months of breastfeeding). We simulated guideline-concordant care for 4 PMTCT regimens: single-dose nevirapine (sdNVP); WHO-recommended Option A, WHO-recommended Option B, and Option B+ (lifelong maternal 3-drug antiretroviral therapy regardless of CD4). Outcomes included maternal and infant life expectancy (LE) and lifetime healthcare costs (2008 US dollars [USD]). Incremental cost-effectiveness ratios (ICERs, in USD per year of life saved [YLS]) were calculated from combined (maternal + infant) discounted costs and LE.
RESULTS: Replacing sdNVP with Option A increased combined maternal and infant LE from 36.97 to 37.89 years and would reduce lifetime costs from $5760 to $5710 per mother-infant pair. Compared with Option A, Option B further improved LE (38.32 years), and saved money within 4 years after delivery ($5630 per mother-infant pair). Option B+ (LE, 39.04 years; lifetime cost, $6620 per mother-infant pair) improved maternal and infant health, with an ICER of $1370 per YLS compared with Option B.
CONCLUSIONS: Replacing sdNVP with Option A or Option B will improve maternal and infant outcomes and save money; Option B increases health benefits and decreases costs compared with Option A. Option B+ further improves maternal outcomes, with an ICER (compared with Option B) similar to many current HIV-related healthcare interventions.
Authors:
Andrea L Ciaranello; Freddy Perez; Barbara Engelsmann; Rochelle P Walensky; Angela Mushavi; Asinath Rusibamayila; Jo Keatinge; Ji-Eun Park; Matthews Maruva; Rodrigo Cerda; Robin Wood; Francois Dabis; Kenneth A Freedberg
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-11-30
Journal Detail:
Title:  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America     Volume:  56     ISSN:  1537-6591     ISO Abbreviation:  Clin. Infect. Dis.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-09     Completed Date:  2013-06-20     Revised Date:  2014-03-19    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  430-46     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Anti-HIV Agents / therapeutic use*
Child
Computer Simulation
Cost-Benefit Analysis
Female
HIV Infections / drug therapy,  transmission*
Humans
Infectious Disease Transmission, Vertical / prevention & control*
Life Expectancy
Practice Guidelines as Topic
Pregnancy
World Health Organization
Young Adult
Zimbabwe
Grant Support
ID/Acronym/Agency:
K01 AI078754/AI/NIAID NIH HHS; K01 AI078754/AI/NIAID NIH HHS; K24 AI062476/AI/NIAID NIH HHS; K24 AI062476/AI/NIAID NIH HHS; P30 AI060354/AI/NIAID NIH HHS; R01 AI058736/AI/NIAID NIH HHS; R01 AI058736/AI/NIAID NIH HHS; UM1 AI068632/AI/NIAID NIH HHS
Chemical
Reg. No./Substance:
0/Anti-HIV Agents
Comments/Corrections
Comment In:
Clin Infect Dis. 2013 Feb;56(3):447-9   [PMID:  23204036 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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