The cost-effectiveness of cotrimoxazole prophylaxis in HIV-infected children in Zambia.
OBJECTIVE
To assess the cost-effectiveness of cotrimoxazole prophylaxis in HIV-infected children in Zambia, as implementation at the local health centre level has yet to be undertaken in many resource-limited countries despite recommendations in recent updated World Health Organization (WHO) guidelines.


METHODS
A probabilistic decision analytical model of HIV/AIDS progression in children based on the CD4 cell percentage (CD4%) was populated with data from the placebo-controlled Children with HIV Antibiotic Prophylaxis trial that had reported a 43% reduction in mortality with cotrimoxazole prophylaxis in HIV-infected children aged 1-14 years.


METHODS
Unit costs (US$ in 2006) were measured at University Teaching Hospital, Lusaka. Cost-effectiveness expressed as cost per life-year saved, cost per quality adjusted life-year (QALY) saved, cost per disability adjusted life-year (DALY) averted was calculated across a number of different scenarios at tertiary and primary healthcare centres.


RESULTS
: Cotrimoxazole prophylaxis was associated with incremental cost-effectiveness ratios (ICERs) of US$72 per life-year saved, US$94 per QALY saved and US$53 per DALY averted, i.e. substantially less than a cost-effectiveness threshold of US$1019 per outcome (gross domestic product per capita, Zambia 2006). ICERs of US$5 or less per outcome demonstrate that cotrimoxazole prophylaxis is even more cost-effective at the local healthcare level. The intervention remained cost-effective in all sensitivity analyses including routine haematological and CD4% monitoring, varying starting age, AIDS status, cotrimoxazole formulation, efficacy duration and discount rates.


CONCLUSIONS
Cotrimoxazole prophylaxis in HIV-infected children is an inexpensive low technology intervention that is highly cost-effective in Zambia, strongly supporting the adoption of WHO guidelines into essential healthcare packages in low-income countries.
Ryan
Máirín
M
National Centre for Pharmacoeconomics, Department of Pharmacology and Therapeutics, Trinity College, Dublin, Ireland. mairin.ryan@ireland.com
Griffin
Susan
S
Chitah
Bona
B
Walker
A Sarah
AS
Mulenga
Veronica
V
Kalolo
Donald
D
Hawkins
Neil
N
Merry
Concepta
C
Barry
Michael G
MG
Chintu
Chifumbe
C
Sculpher
Mark J
MJ
Gibb
Diana M
DM
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D016527:Drug Costs; D005260:Female; D005500:Follow-Up Studies; D006678:HIV; D015658:HIV Infections / Q000191:economics* / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D008297:Male; D008390:Markov Chains; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000191:economics* / Q000627:therapeutic use*; D015024:Zambia
D015662:Trimethoprim, Sulfamethoxazole Drug Combination