title: Costs and benefits of multidrug, multidose antiretroviral therapy for prevention of mother-to-child transmission of HIV in the Dominican Republic.
abstract: OBJECTIVE
  To investigate whether costs of multidose antiretroviral regimens (MD-ARVs), including highly active antiretroviral therapy (HAART), for prevention of mother-to-child transmission (PMTCT) of HIV might be offset by savings gained from treating fewer perinatally acquired infections.
  
  
  METHODS
  Rates of MTCT reported in the Dominican Republic among mother-infant pairs treated with single-dose nevirapine (SD-NVP; n=39) and MD-ARVs (n=91) for PMTCT were compared. Annual births to women infected with HIV were estimated from seroprevalence studies. Antiretroviral costs for both PMTCT and for HAART during the first 2 years of life (in cases of perinatal infection) were based on 2008 low-income country price estimates.
  
  
  RESULTS
  Rates of MTCT were 3.3% and 15.4% for the MD-ARV and SD-NVP groups, respectively (P=0.02). Assuming that 5775 of 231 000 annual births (2.5%) were to HIV-positive women, it was estimated that 191 perinatally acquired infections would occur using MD-ARVs and 889 using SD-NVP. High costs of maternal MD-ARVs (HAART, US$914,760 versus SD-NVP, $1155) would be offset by lower 2-year HAART costs ($250,344 versus $1,168,272 for infants in the SD-NVP group) for the lower number of children with prenatally acquired infection (191 versus 889) associated with the use of MD-ARVs for PMTCT (net national saving $3168).
  
  
  CONCLUSIONS
  Despite the high costs, use of MD-ARVs, such as HAART, for PMTCT offer societal savings because fewer perinatally acquired infections are anticipated to require treatment.
authors.affiliation: Department of Obstetrics and Gynecology, Service of Gynecology, Geneva University Hospital, Geneva, Switzerland. nicole.kley@hcuge.ch
authors.forename: Nicole C
authors.initials: NC
authors.lastname: Schmidt
authors.forename: José
authors.initials: J
authors.lastname: Roman-Pouriet
authors.forename: Aracelis D
authors.initials: AD
authors.lastname: Fernandez
authors.forename: Consuelo M
authors.initials: CM
authors.lastname: Beck-Sagué
authors.forename: José
authors.initials: J
authors.lastname: Leonardo-Guerrero
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Nicholas
mesh_terms: D000480:Alkynes; D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D048588:Benzoxazines / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003521:Cyclopropanes; D004293:Dominican Republic; D004334:Drug Administration Schedule; D016527:Drug Costs; D005260:Female; D015658:HIV Infections / Q000191:economics / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000191:economics / Q000517:prevention & control*; D019259:Lamivudine / Q000191:economics / Q000627:therapeutic use*; D019829:Nevirapine / Q000191:economics / Q000627:therapeutic use*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D015215:Zidovudine / Q000191:economics / Q000627:therapeutic use*
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D019259:Lamivudine; D015215:Zidovudine; D019829:Nevirapine; C098320:efavirenz