title: The cost-effectiveness of different feeding patterns combined with prompt treatments for preventing mother-to-child HIV transmission in South Africa: estimates from simulation modeling.
abstract: OBJECTIVE
  Based on the important changes in South Africa since 2009 and the Antiretroviral Treatment Guideline 2013 recommendations, we explored the cost-effectiveness of different strategy combinations according to the South African HIV-infected mothers' prompt treatments and different feeding patterns.
  
  
  METHODS
  A decision analytic model was applied to simulate cohorts of 10,000 HIV-infected pregnant women to compare the cost-effectiveness of two different HIV strategy combinations: (1) Women were tested and treated promptly at any time during pregnancy (Promptly treated cohort). (2) Women did not get testing or treatment until after delivery and appropriate standard treatments were offered as a remedy (Remedy cohort). Replacement feeding or exclusive breastfeeding was assigned in both strategies. Outcome measures included the number of infant HIV cases averted, the cost per infant HIV case averted, and the cost per life year (LY) saved from the interventions. One-way and multivariate sensitivity analyses were performed to estimate the uncertainty ranges of all outcomes.
  
  
  RESULTS
  The remedy strategy does not particularly cost-effective. Compared with the untreated baseline cohort which leads to 1127 infected infants, 698 (61.93%) and 110 (9.76%) of pediatric HIV cases are averted in the promptly treated cohort and remedy cohort respectively, with incremental cost-effectiveness of $68.51 and $118.33 per LY, respectively. With or without the antenatal testing and treatments, breastfeeding is less cost-effective ($193.26 per LY) than replacement feeding ($134.88 per LY), without considering the impact of willingness to pay.
  
  
  CONCLUSIONS
  Compared with the prompt treatments, remedy in labor or during the postnatal period is less cost-effective. Antenatal HIV testing and prompt treatments and avoiding breastfeeding are the best strategies. Although encouraging mothers to practice replacement feeding in South Africa is far from easy and the advantages of breastfeeding can not be ignored, we still suggest choosing replacement feeding as far as possible.
authors: Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China.
authors: Wenhua
authors: W
authors: Yu
authors: Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China.
authors: Changping
authors: C
authors: Li
authors: Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China.
authors: Xiaomeng
authors: X
authors: Fu
authors: Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China.
authors: Zhuang
authors: Z
authors: Cui
authors: Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China.
authors: Xiaoqian
authors: X
authors: Liu
authors: Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China.
authors: Linlin
authors: L
authors: Fan
authors: Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China.
authors: Guan
authors: G
authors: Zhang
authors: Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin, China.
authors: Jun
authors: J
authors: Ma
mesh_terms: D044966:Anti-Retroviral Agents / Q000191:economics / Q000627:therapeutic use*; D001942:Breast Feeding; D015331:Cohort Studies; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D005247:Feeding Behavior; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000191:economics / Q000517:prevention & control*; D018803:Models, Economic; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000379:methods; D011247:Pregnancy; D013019:South Africa
chemical_list: D044966:Anti-Retroviral Agents