Comparative cost-effectiveness of Option B+ for prevention of mother-to-child transmission of HIV in Malawi.
AIDS
; 30(6): 953-62, 2016 Mar 27.
Article
em En
| MEDLINE
| ID: mdl-26691682
ABSTRACT
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 10â000 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.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Complicações Infecciosas na Gravidez
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Infecções por HIV
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Análise Custo-Benefício
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Transmissão Vertical de Doenças Infecciosas
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Terapia Antirretroviral de Alta Atividade
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Antirretrovirais
Tipo de estudo:
Health_economic_evaluation
Aspecto:
Patient_preference
Limite:
Adult
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Female
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Humans
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Infant
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Male
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Newborn
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Pregnancy
País/Região como assunto:
Africa
Idioma:
En
Revista:
AIDS
Assunto da revista:
SINDROME DA IMUNODEFICIENCIA ADQUIRIDA (AIDS)
Ano de publicação:
2016
Tipo de documento:
Article