title: Cost-effectiveness of World Health Organization 2010 guidelines for prevention of mother-to-child HIV transmission in Zimbabwe.
abstract: BACKGROUND
  In 2010, the World Health Organization (WHO) released revised guidelines for prevention of mother-to-child human immunodeficiency virus (HIV) transmission (PMTCT). We projected clinical impacts, costs, and cost-effectiveness of WHO-recommended PMTCT strategies in Zimbabwe.
  
  
  METHODS
  We used Zimbabwean data in a validated computer model to simulate a cohort of pregnant, HIV-infected women (mean age, 24 years; mean CD4 count, 451 cells/µL; subsequent 18 months of breastfeeding). We simulated guideline-concordant care for 4 PMTCT regimens: single-dose nevirapine (sdNVP); WHO-recommended Option A, WHO-recommended Option B, and Option B+ (lifelong maternal 3-drug antiretroviral therapy regardless of CD4). Outcomes included maternal and infant life expectancy (LE) and lifetime healthcare costs (2008 US dollars [USD]). Incremental cost-effectiveness ratios (ICERs, in USD per year of life saved [YLS]) were calculated from combined (maternal + infant) discounted costs and LE.
  
  
  RESULTS
  Replacing sdNVP with Option A increased combined maternal and infant LE from 36.97 to 37.89 years and would reduce lifetime costs from $5760 to $5710 per mother-infant pair. Compared with Option A, Option B further improved LE (38.32 years), and saved money within 4 years after delivery ($5630 per mother-infant pair). Option B+ (LE, 39.04 years; lifetime cost, $6620 per mother-infant pair) improved maternal and infant health, with an ICER of $1370 per YLS compared with Option B.
  
  
  CONCLUSIONS
  Replacing sdNVP with Option A or Option B will improve maternal and infant outcomes and save money; Option B increases health benefits and decreases costs compared with Option A. Option B+ further improves maternal outcomes, with an ICER (compared with Option B) similar to many current HIV-related healthcare interventions.
authors.affiliation: Medical Practice Evaluation Center, Divisions of Infectious Disease, Massachusetts General Hospital, Boston, MA 02114, USA. aciaranello@partners.org
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Ciaranello
authors.forename: Freddy
authors.initials: F
authors.lastname: Perez
authors.forename: Barbara
authors.initials: B
authors.lastname: Engelsmann
authors.forename: Rochelle P
authors.initials: RP
authors.lastname: Walensky
authors.forename: Angela
authors.initials: A
authors.lastname: Mushavi
authors.forename: Asinath
authors.initials: A
authors.lastname: Rusibamayila
authors.forename: Jo
authors.initials: J
authors.lastname: Keatinge
authors.forename: Ji-Eun
authors.initials: JE
authors.lastname: Park
authors.forename: Matthews
authors.initials: M
authors.lastname: Maruva
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Cerda
authors.forename: Robin
authors.initials: R
authors.lastname: Wood
authors.forename: Francois
authors.initials: F
authors.lastname: Dabis
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008017:Life Expectancy; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D014944:World Health Organization; D055815:Young Adult; D015030:Zimbabwe
chemical_list: D019380:Anti-HIV Agents