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Cost-effectiveness of new WHO recommendations for prevention of mother-to-child transmission of HIV in a resource-limited setting

Shah, Maunanka; Johns, Benjaminb; Abimiku, Alash'lec; Walker, Damian Gb

doi: 10.1097/QAD.0b013e32834670b9
Epidemiology and Social

Objective: Nigeria has high rates of mother-to-child HIV transmission. We sought to determine whether new WHO recommendations for long-course antiretroviral therapy (ART) prophylaxis are cost-effective for prevention of mother-to-child transmission (PMTCT) of HIV compared to short-course strategies in Nigeria.

Design: We conducted a cost-effectiveness analysis from a health-system perspective, with a target population consisting of HIV-infected pregnant women in Nigeria.

Methods: A decision-analysis model compared two strategies for PMTCT: intervention – long-course maternal triple ART [zidovudine/lamivudine/efavirenz (ZDV/3TC/EFV)] beginning at 14 weeks gestation through the end of breastfeeding, with infant ART, per new WHO guidelines (option B); and minimal standard of care (MSOC) in Nigeria – short-course dual ART (ZDV/3TC) from 34 weeks gestation to 1 week postpartum, with single-dose nevirapine for infant and mother at labor/delivery. The primary outcomes were expected costs, pediatric HIV cases, and disability-adjusted life years (DALYs) accrued with each strategy; cost-effectiveness was represented using incremental cost-effectiveness ratios (ICERs).

Results: If implemented at the level of antenatal coverage in Nigeria (58%), mother-to-child HIV transmission could be reduced to 16.1% with MSOC and 12.8% with the intervention. At current pregnancy rates, the intervention would prevent 7680 infant HIV cases and avert 230 400 DALYs annually, compared to MSOC. The average health-system cost of the intervention was US$ 401 per pregnancy compared to $293 per pregnancy with MSOC. The intervention was associated with an ICER of $113 per-DALY-averted compared to MSOC, and was highly cost-effective using a willingness-to-pay threshold of per-capita Nigerian GDP.

Conclusion: Implementation of new WHO recommendations for extended maternal and infant prophylaxis is highly cost-effective compared to short-course regimens for PMTCT of HIV in Nigeria.

aDivision of Infectious Diseases, Department of Medicine, Johns Hopkins University, School of Medicine, USA

bDepartment of International Health, Johns Hopkins University, Bloomberg School of Public Health, USA

cInstitute of Human Virology, University of Maryland, School of Medicine, Baltimore, Maryland, USA.

Received 17 December, 2010

Revised 1 March, 2011

Accepted 4 March, 2011

Correspondence to Maunank Shah, MD, Clinical Instructor, Division of Infectious Disease, Department of Medicine, 1503 East Jefferson St, Room 118, Baltimore, MD 21231, USA. Tel: +1 443 287 0401; fax: +1 410 955 0740; e-mail: Mshah28@JHMI.EDU

© 2011 Lippincott Williams & Wilkins, Inc.