title: Cost-effectiveness of using HAART in prevention of mother-to-child transmission in the DREAM-Project Malawi.
abstract: BACKGROUND
  Cost-effectiveness analysis are crucial in the management of the HIV/AIDS epidemic, particularly in resource-limited settings. Such analyses have not been performed in the use of highly active antiretroviral therapy (HAART) for prevention of mother-to-child transmission (PMTCT).
  
  
  OBJECTIVE
  Cost-effectiveness analysis of HAART approach in Malawi for PMTCT.
  
  
  METHODS
  In 2 health centres in Malawi 6500 pregnant women were tested; 1118 pregnant women completed the entire Drug Resource Enhancement against Aids and Malnutrition-Project Malawi (DREAM - PM) PMTCT protocol. The costs of the intervention were calculated using the ingredients method. Outcomes estimated were cost for infection averted and cost for DALY saved compared with no intervention.
  
  
  RESULTS
  From a private perspective cost for HIV infection averted was US $998 and cost per DALY saved was US $35.36. From a public perspective, the result became negative as follows: -261 and -16.55, respectively (lower cost than the cost of the therapy for an HIV+ child). The univariate sensitivity analysis showed that the cost for DALY saved always remained under the threshold of US $50, largely under the threshold given by the per capita yearly income in Malawi (US $667 PPD).
  
  
  CONCLUSIONS
  Administration of HAART in a PMTCT programme in resource-limited settings is cost-effective. Drugs and laboratory tests are the most significant costs, but further reduction of these expenses is possible.
authors.affiliation: Department of Public Health, University of Perugia, Perugia, Italy. steorlando@gmail.com
authors.forename: Stefano
authors.initials: S
authors.lastname: Orlando
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Marazzi
authors.forename: Sandro
authors.initials: S
authors.lastname: Mancinelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Liotta
authors.forename: Susanna
authors.initials: S
authors.lastname: Ceffa
authors.forename: Pietro
authors.initials: P
authors.lastname: Giglio
authors.forename: Ellard
authors.initials: E
authors.lastname: Alumando
authors.forename: Isabelle
authors.initials: I
authors.lastname: Ziegler
authors.forename: Mary
authors.initials: M
authors.lastname: Shawa
authors.forename: Leonardo
authors.initials: L
authors.lastname: Palombi
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics*; D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics / Q000517:prevention & control* / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D009035:Mothers; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy
chemical_list: D019380:Anti-HIV Agents