title: Economic evaluation of 3-drug antiretroviral regimens for the prevention of mother-to-child HIV transmission in Thailand.
abstract: The current program for prevention of mother-to-child HIV transmission in Thailand recommends a 2-drugs regimen for HIV-infected pregnant women with a CD4 count >200 cells/mm(3). This study assesses the value for money of 3 antiretroviral drugs compared with zidovudine (AZT)+single-dose nevirapine (sd-NVP). A decision tree was constructed to predict costs and outcomes using the governmental perspective for assessing cost-effectiveness of 3-drug regimens: (1) AZT, lamivudine, and efavirenz and (2) AZT, 3TC, and lopinavir/ritonavir, in comparison with the current protocol, AZT+sd-NVP. The 3-drug antiretroviral regimens yield lower costs and better health outcomes compared with AZT+sd-NVP. Although these 3-drug regimens offer higher program costs and health care costs for premature birth, they save money significantly in regard to pediatric HIV treatment and treatment costs for drug resistance in mothers. The 3-drug regimens are cost-saving interventions. The findings from this study were used to support a policy change in the national recommendation.
authors.affiliation: Health Intervention and Technology Assessment Program, Nonthaburi, Thailand pitsaphun.w@hitap.net.
authors.forename: Pitsaphun
authors.initials: P
authors.lastname: Werayingyong
authors.affiliation: The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
authors.forename: Nittaya
authors.initials: N
authors.lastname: Phanuphak
authors.affiliation: Mahidol University, Bangkok, Thailand.
authors.forename: Kulkunya
authors.initials: K
authors.lastname: Chokephaibulkit
authors.affiliation: Health Intervention and Technology Assessment Program, Nonthaburi, Thailand.
authors.forename: Sripen
authors.initials: S
authors.lastname: Tantivess
authors.affiliation: Ministry of Public Health, Nonthaburi, Thailand.
authors.forename: Nareeluk
authors.initials: N
authors.lastname: Kullert
authors.affiliation: Health Intervention and Technology Assessment Program, Nonthaburi, Thailand.
authors.forename: Kakanang
authors.initials: K
authors.lastname: Tosanguan
authors.affiliation: Health Intervention and Technology Assessment Program, Nonthaburi, Thailand.
authors.forename: Rukmanee
authors.initials: R
authors.lastname: Butchon
authors.affiliation: Ministry of Public Health, Nonthaburi, Thailand.
authors.forename: Nipunporn
authors.initials: N
authors.lastname: Voramongkol
authors.affiliation: Benjalak Hospital, Nonthaburi, Thailand.
authors.forename: Sarawut
authors.initials: S
authors.lastname: Boonsuk
authors.affiliation: Health Intervention and Technology Assessment Program, Nonthaburi, Thailand.
authors.forename: Songyot
authors.initials: S
authors.lastname: Pilasant
authors.affiliation: Health Intervention and Technology Assessment Program, Nonthaburi, Thailand.
authors.forename: Wantanee
authors.initials: W
authors.lastname: Kulpeng
authors.affiliation: Health Intervention and Technology Assessment Program, Nonthaburi, Thailand.
authors.forename: Yot
authors.initials: Y
authors.lastname: Teerawattananon
mesh_terms: D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000191:economics*; D048588:Benzoxazines / Q000008:administration & dosage / Q000191:economics; D018791:CD4 Lymphocyte Count; D003362:Cost-Benefit Analysis; D003521:Cyclopropanes; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D019259:Lamivudine / Q000008:administration & dosage / Q000191:economics; D017059:Models, Econometric; D009035:Mothers; D019829:Nevirapine / Q000008:administration & dosage / Q000191:economics; D011247:Pregnancy; D013785:Thailand; D015215:Zidovudine / Q000008:administration & dosage / Q000191:economics
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D019259:Lamivudine; D015215:Zidovudine; D019829:Nevirapine; C098320:efavirenz
keywords: ARV; HIV; PMTCT; mother-to-child transmission; vertical transmission