title: Cost effectiveness of option B plus for prevention of mother-to-child transmission of HIV in resource-limited countries: evidence from Kumasi, Ghana.
abstract: BACKGROUND
  Achieving the goal of eliminating mother-to-child HIV transmission (MTCT) necessitates increased access to antiretroviral therapy (ART) for HIV-infected pregnant women. Option B provides ART through pregnancy and breastfeeding, whereas Option B+ recommends continuous ART regardless of CD4 count, thus potentially reducing MTCT during future pregnancies. Our objective was to compare maternal and pediatric health outcomes and cost-effectiveness of Option B+ versus Option B in Ghana.
  
  
  METHODS
  A decision-analytic model was developed to simulate HIV progression in mothers and transmission (in utero, during birth, or through breastfeeding) to current and all future children. Clinical parameters, including antenatal care access and fertility rates, were estimated from a retrospective review of 817 medical records at two hospitals in Ghana. Additional parameters were obtained from published literature. Modeled outcomes include HIV infections averted among newborn children, quality-adjusted life-years (QALYs), and cost-effectiveness ratios.
  
  
  RESULTS
  HIV-infected women in Ghana have a lifetime average of 2.3 children (SD 1.3). Projected maternal life expectancy under Option B+ is 16.1 years, versus 16.0 years with Option B, yielding a gain of 0.1 maternal QALYs and 3.2 additional QALYs per child. Despite higher initial ART costs, Option B+ costs $785/QALY gained, a value considered very cost-effective by World Health Organization benchmarks. Widespread implementation of Option B+ in Ghana could theoretically prevent up to 668 HIV infections among children annually. Cost-effectiveness estimates remained favorable over robust sensitivity analyses.
  
  
  CONCLUSIONS
  Although more expensive than Option B, Option B+ substantially reduces MTCT in future pregnancies, increases both maternal and pediatric QALYs, and is a cost-effective use of limited resources in Ghana.
authors.affiliation: Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA. avandeusen@gmail.com.
authors.forename: Adam
authors.initials: A
authors.lastname: VanDeusen
authors.affiliation: Departments of Pediatrics & Pharmacology, Yale School of Medicine, Yale Child Health Research Center, 464 Congress Ave, New Haven, CT, USA. Elijah.paintsil@yale.edu.
authors.forename: Elijah
authors.initials: E
authors.lastname: Paintsil
authors.affiliation: Department of Pharmacy, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. tagyarkopoku@gmail.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Agyarko-Poku
authors.affiliation: University of California Los Angeles, Anderson School of Management, Los Angeles, CA, USA. elisa.long@anderson.ucla.edu.
authors.forename: Elisa F
authors.initials: EF
authors.lastname: Long
mesh_terms: D044966:Anti-Retroviral Agents / Q000191:economics* / Q000627:therapeutic use*; D001942:Breast Feeding / Q000706:statistics & numerical data; D018890:Chemoprevention / Q000191:economics* / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D005260:Female; D005869:Ghana / Q000453:epidemiology; D015658:HIV Infections / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D015497:HIV-1; D006295:Health Resources / Q000191:economics; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000191:economics / Q000517:prevention & control / Q000706:statistics & numerical data; D017059:Models, Econometric; D009034:Mother-Child Relations; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies
chemical_list: D044966:Anti-Retroviral Agents