title: Cost-effectiveness of a package of interventions for expedited antiretroviral therapy initiation during pregnancy in Cape Town, South Africa.
abstract: Initiating antiretroviral therapy (ART) early in pregnancy is an important component of effective interventions to prevent the mother-to-child transmission of HIV (PMTCT). The rapid initiation of ART in pregnancy(RAP) program was a package of interventions to expedite ART initiation in pregnant women in Cape Town, South Africa. Retrospective cost-effectiveness, sensitivity and threshold analyses were conducted of the RAP program to determine the cost-utility thresholds for rapid initiation of ART in pregnancy. Costs were drawn from a detailed micro-costing of the program. The overall programmatic cost was US$880 per woman and the base case cost-effectiveness ratio was US$1,160 per quality-adjusted lifeyear (QALY) saved. In threshold analyses, the RAP program remained cost-effective if mother-to-child transmission was reduced by C0.33 %; if C1.76 QALY were saved with each averted perinatal infection; or if RAP-related costs were under US$4,020 per woman. The package of rapid initiation services was very cost-effective, as compared to standard services in this setting. Threshold analyses demonstrated that the intervention required minimal reductions in perinatal infections in order to be cost-effective. Interventions for the rapid initiation of ART in pregnancy hold considerable potential as a cost-effective use of limited resources for PMTCT in sub-Saharan Africa.
authors.forename: Rose
authors.initials: R
authors.lastname: Zulliger
authors.forename: Samantha
authors.initials: S
authors.lastname: Black
authors.forename: David R
authors.initials: DR
authors.lastname: Holtgrave
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Ciaranello
authors.forename: Linda-Gail
authors.initials: LG
authors.lastname: Bekker
authors.forename: Landon
authors.initials: L
authors.lastname: Myer
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D001942:Breast Feeding; D018791:CD4 Lymphocyte Count; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology / Q000517:prevention & control*; D017048:Health Care Costs; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000191:economics* / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D013019:South Africa; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents