Cost-effectiveness of strategies to reduce mother-to-child HIV transmission in Mexico, a low-prevalence setting.
OBJECTIVE
To estimate and compare the cost-effectiveness of selected interventions to reduce mother-to-child transmission (MTCT) of HIV in Mexico.


METHODS
A spreadsheet-based model was used to examine five scenarios, each estimated using both zidovudine (ZDV) and nevirapine (NVP). Scenarios differ according to coverage, type of voluntary counselling and testing (VCT), restriction to women at higher risk, and whether rapid testing is offered at delivery. Averted adult infections due to VCT are also estimated, as are savings due to averted treatment costs. Results are reported as cost per child infection prevented, net of averted treatment costs (C/CIP).


RESULTS
Among 958294 women attending public antenatal clinics, increasing VCT coverage from 4% to 85% is estimated to prevent 102 paediatric and 8 adult infections at a C/CIP of US dollars 42517 using ZDV. In the most restrictive scenario (III), 46 paediatric infections are prevented with a C/CIP of US dollars 39220. Use of NVP increases C/CIP because the reduced drug cost is more than offset by its reduced assumed effectiveness. The cost of detecting infected women (approximately 90% of total) far exceeds treatment costs in such a low-prevalence setting.


CONCLUSIONS
Minimization of MTCT costs in low-prevalence settings should focus on VCT costs rather than drug costs. Even the most cost-effective scenario modelled compares unfavourably with other, highly cost-effective maternal/child interventions that still do not reach many Mexicans. However, it compares favourably against several therapeutic maternal/child interventions available in the public sector's tertiary care hospitals.
Rely
Kely
K
Health Economics Unit, Instituto Mexicano de Seguro Social, Mexico City, Mexico.
Bertozzi
Stefano M
SM
Avila-Figueroa
Carlos
C
Guijarro
Maria Teresa
MT
D015492:AIDS Serodiagnosis / Q000191:economics*; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000191:economics; D001942:Breast Feeding; D002585:Cesarean Section / Q000191:economics; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003376:Counseling / Q000191:economics; D005260:Female; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000191:economics / Q000517:prevention & control*; D008800:Mexico / Q000453:epidemiology; D019829:Nevirapine / Q000008:administration & dosage / Q000191:economics; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D011295:Prenatal Care / Q000191:economics* / Q000379:methods; D026712:Value of Life / Q000191:economics; D015215:Zidovudine / Q000008:administration & dosage / Q000191:economics
D019380:Anti-HIV Agents; D015215:Zidovudine; D019829:Nevirapine