title: Cost-effectiveness analysis of Option B+ for HIV prevention and treatment of mothers and children in Malawi.
abstract: BACKGROUND
  The Ministry of Health in Malawi is implementing a pragmatic and innovative approach for the management of all HIV-infected pregnant women, termed Option B+, which consists of providing life-long antiretroviral treatment, regardless of their CD4 count or clinical stage. Our objective was to determine if Option B+ represents a cost-effective option.
  
  
  METHODS
  A decision model simulates the disease progression of a cohort of HIV-infected pregnant women receiving prophylaxis and antiretroviral therapy, and estimates the number of paediatric infections averted and maternal life years gained over a ten-year time horizon. We assess the cost-effectiveness from the Ministry of Health perspective while taking into account the practical realities of implementing ART services in Malawi.
  
  
  RESULTS
  If implemented as recommended by the World Health Organization, options A, B and B+ are equivalent in preventing new infant infections, yielding cost effectiveness ratios between US$ 37 and US$ 69 per disability adjusted life year averted in children. However, when the three options are compared to the current practice, the provision of antiretroviral therapy to all mothers (Option B+) not only prevents infant infections, but also improves the ten-year survival in mothers more than four-fold. This translates into saving more than 250,000 maternal life years, as compared to mothers receiving only Option A or B, with savings of 153,000 and 172,000 life years respectively. Option B+ also yields favourable incremental cost effectiveness ratios (ICER) of US$ 455 per life year gained over the current practice.
  
  
  CONCLUSIONS
  In Malawi, Option B+ represents a favorable policy option from a cost-effectiveness perspective to prevent future infant infections, save mothers' lives and reduce orphanhood. Although Option B+ would require more financial resources initially, it would save societal resources in the long-term and represents a strategic option to simplify and integrate HIV services into maternal, newborn and child health programmes.
authors.affiliation: Master of International Health Management, Economics and Policy Program, SDA Bocconi School of Management, Milan, Italy.
authors.forename: Olufunke
authors.initials: O
authors.lastname: Fasawe
authors.forename: Carlos
authors.initials: C
authors.lastname: Avila
authors.forename: Nathan
authors.initials: N
authors.lastname: Shaffer
authors.forename: Erik
authors.initials: E
authors.lastname: Schouten
authors.forename: Frank
authors.initials: F
authors.lastname: Chimbwandira
authors.forename: David
authors.initials: D
authors.lastname: Hoos
authors.forename: Olive
authors.initials: O
authors.lastname: Nakakeeto
authors.forename: Paul
authors.initials: P
authors.lastname: De Lay
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000191:economics; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D005260:Female; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008295:Malawi / Q000453:epidemiology; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control; D014944:World Health Organization
chemical_list: D000998:Antiviral Agents
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