Cost effectiveness of single-dose nevirapine regimen for mothers and babies to decrease vertical HIV-1 transmission in sub-Saharan Africa.
BACKGROUND
Identification of economical interventions to decrease HIV-1 transmission to children is an urgent public-health priority in sub-Saharan Africa. We assessed the cost effectiveness of the HIVNET 012 nevirapine regimen.


METHODS
We assessed cost effectiveness in a hypothetical cohort of 20,000 pregnant women in sub-Saharan Africa. Our main outcome measures were programme cost, paediatric HIV-1 cases averted, cost per case averted, and cost per disability-adjusted life-year (DALY). We compared HIVNET 012 with other short-course antiretroviral regimens. We also compared two implementation strategies: counselling and HIV-1 testing before treatment (targeted treatment), or nevirapine for all pregnant women (universal treatment, no counselling and testing). We did univariate and multivariate sensitivity analyses.


RESULTS
For universal treatment with 30% HIV-1 seroprevalence, the HIVNET 012 regimen would avert 603 cases of HIV-1 in babies, cost US$83,333, and generate 15,862 DALYs. The associated cost-effectiveness ratios were $138 per case averted or $5.25 per DALY. At 15% seroprevalence, the universal treatment option would cost $83,333 and avert 302 cases at $276 per case averted or $10.51 per DALY. For targeted treatment at 30% seroprevalence, HIVNET 012 would cost $141,922 and avert 476 cases at $298 per case averted or $11.29 per DALY. With seroprevalence higher than 3.0% for universal and 4.5% for targeted treatment, the HIVNET 012 regimen was likely to be as cost effective as other public-health interventions. The cost effectiveness of HIVNET 012 was robust under a wide range of parameters in the sensitivity analysis.


CONCLUSIONS
The HIVNET 012 regimen can be highly cost-effective in high seroprevalence settings. In lower seroprevalence areas, when multidose regimens are not cost effective, nevirapine therapy could have a major public-health impact at a reasonable cost.
Marseille
E
E
Health Strategies International, Orinda, CA 94563, USA. emarseille@home.com
Kahn
J G
JG
Mmiro
F
F
Guay
L
L
Musoke
P
P
Fowler
M G
MG
Jackson
J B
JB
D017954:Africa South of the Sahara / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000191:economics* / Q000517:prevention & control / Q000635:transmission*; D015528:HIV Seroprevalence; D015497:HIV-1; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000191:economics / Q000517:prevention & control*; D018803:Models, Economic; D019829:Nevirapine / Q000008:administration & dosage* / Q000191:economics* / Q000627:therapeutic use; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology*; D012680:Sensitivity and Specificity
D019380:Anti-HIV Agents; D019829:Nevirapine