Cost-effectiveness of antiviral drug therapy to reduce mother-to-child HIV transmission in sub-Saharan Africa.
OBJECTIVE
To assess the potential cost-effectiveness of short-course antiviral regimens to prevent mother-to-child transmission (MCT) of HIV in sub-Saharan Africa.


METHODS
Cost-effectiveness analysis.


METHODS
No intervention was compared with three regimens of twice daily zidovudine and lamivudine: regimen A, starting at 36 weeks of gestation and continuing to 1 week postpartum; regimen B, from intrapartum through 1 week postpartum; and regimen C, intrapartum only. Model inputs were estimated from published and unpublished data. Absolute percentage reductions in HIV transmission extrapolated from zidovudine monotherapy trials were estimated at 12.4, 8.6 and 4.3% for regimens A, B, and C, respectively. Outcome measures were net costs to the public sector health-care system, cost per infection averted, and cost per disability-adjusted life-year (DALY) gained. Multiple sensitivity analyses were conducted.


RESULTS
Based on the hypothetical efficacy estimates, regimen C was the most cost-effective. For a cohort of 100 women with 15% HIV prevalence, net costs to the public sector health-care systems were estimated at US$3617 for regimen A, US$ 1667 for regimen B, and US$351 for regimen C. Regimen C had a cost of US$ 1129 per HIV infection averted and a cost of US$60 per DALY. Regimens B and A cost US$2680 and 5134 per infection averted and US$143 and 274 per DALY, respectively. Cost-effectiveness declined rapidly at efficacy below 10% or HIV prevalence below 7%. Results were very sensitive to antiviral drug costs. For example, at 20% of current prices, the cost per DALY for regimen A fell to US$64, and to about US$42 for regimens B and C.


CONCLUSIONS
Antiviral therapy may be cost-effective compared with other health interventions if HIV prevalence is high, if clinical trials confirm estimated efficacies, and if drug prices are reduced.
Marseille
E
E
Insititute of Health Policy Studies, University of California, San Francisco 94109, USA.
Kahn
J G
JG
Saba
J
J
D017954:Africa South of the Sahara; D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use*; D001942:Breast Feeding; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control* / Q000635:transmission*; D015528:HIV Seroprevalence; D017048:Health Care Costs; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000191:economics / Q000517:prevention & control*; D019259:Lamivudine / Q000191:economics / Q000627:therapeutic use; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000191:economics*; D016896:Treatment Outcome; D015215:Zidovudine / Q000191:economics / Q000627:therapeutic use
D019380:Anti-HIV Agents; D019259:Lamivudine; D015215:Zidovudine