The costs and benefits of Option B+ for the prevention of mother-to-child transmission of HIV.
OBJECTIVE
Most countries follow WHO 2010 guidelines for the prevention of mother-to-child transmission (PMTCT) of HIV using either Option A or B for women not yet eligible for antiretroviral therapy (ART). Both of these approaches involve the use of antiretrovirals during pregnancy and breastfeeding. Some countries have adopted a new strategy, Option B+, in which HIV-positive pregnant women are started immediately on ART and continued for life. Option B+ is more costly than Options A or B, but provides additional health benefits. In this article, we estimate the additional costs and effectiveness of Option B+.


METHODS
We developed a deterministic model to simulate births, breastfeeding, and HIV infection in women in four countries, Kenya, Zambia, South Africa, and Vietnam that differ in fertility rate, birth interval, age at first birth, and breastfeeding patterns, but have similar age at HIV infection. We estimated the total PMTCT costs and new child infections under Options A, B, and B+, and measured cost-effectiveness as the incremental PMTCT-related costs per child infection averted. We included adult sexual transmissions averted from ART, the corresponding costs saved, and estimated the total incremental cost per transmission (child and adult) averted.


RESULTS
When considering PMTCT-related costs and child infections, Option B+ was the most cost-effective strategy costing between $6000 and $23 000 per infection averted compared with Option A. Option B+ averted more child infections compared with Option B in all four countries and cost less than Option B in Kenya and Zambia. When including adult sexual transmissions averted, Option B+ cost less and averted more infections than Options A and B.
aFutures Institute, Glastonbury, Connecticut, USA bWorld Health Organization cUNAIDS, Geneva, Switzerland.
Chaitra
C
Gopalappa
John
J
Stover
Nathan
N
Shaffer
Mary
M
Mahy
D000293:Adolescent; D000328:Adult; D000349:Africa; D044966:Anti-Retroviral Agents / Q000008:administration & dosage* / Q000191:economics*; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000191:economics* / Q000517:prevention & control*; D008875:Middle Aged; D011247:Pregnancy; D014744:Vietnam; D055815:Young Adult
D044966:Anti-Retroviral Agents