title: Comparative cost-effectiveness of Option B+ for prevention of mother-to-child transmission of HIV in Malawi.
abstract: OBJECTIVE
  To estimate the cost-effectiveness of prevention of mother-to-child transmission (MTCT) of HIV with lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women ('Option B+') compared with ART during pregnancy or breastfeeding only unless clinically indicated ('Option B').
  
  
  METHODS
  Mathematical modelling study of first and second pregnancy, informed by data from the Malawi Option B+ programme.
  
  
  METHODS
  Individual-based simulation model. We simulated cohorts of 10 000 women and their infants during two subsequent pregnancies, including the breastfeeding period, with either Option B+ or B. We parameterized the model with data from the literature and by analysing programmatic data. We compared total costs of antenatal and postnatal care, and lifetime costs and disability-adjusted life-years of the infected infants between Option B+ and Option B.
  
  
  RESULTS
  During the first pregnancy, 15% of the infants born to HIV-infected mothers acquired the infection. With Option B+, 39% of the women were on ART at the beginning of the second pregnancy, compared with 18% with Option B. For second pregnancies, the rates MTCT were 11.3% with Option B+ and 12.3% with Option B. The incremental cost-effectiveness ratio comparing the two options ranged between about US$ 500 and US$ 1300 per DALY averted.
  
  
  CONCLUSIONS
  Option B+ prevents more vertical transmissions of HIV than Option B, mainly because more women are already on ART at the beginning of the next pregnancy. Option B+ is a cost-effective strategy for PMTCT if the total future costs and lost lifetime of the infected infants are taken into account.
authors.affiliation: aThe International Union Against Tuberculosis and Lung Disease, Paris, France bLighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi cInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland dDepartment of HIV and AIDS, Ministry of Health, Lilongwe, Malawi eInternational Training and Education Center for Health, University of Washington, Seattle, Washington, USA fCentre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Hannock
authors.initials: H
authors.lastname: Tweya
authors.forename: Olivia
authors.initials: O
authors.lastname: Keiser
authors.forename: Andreas D
authors.initials: AD
authors.lastname: Haas
authors.forename: Lyson
authors.initials: L
authors.lastname: Tenthani
authors.forename: Sam
authors.initials: S
authors.lastname: Phiri
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
authors.forename: Janne
authors.initials: J
authors.lastname: Estill
mesh_terms: 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* / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008295:Malawi; D008297:Male; D008962:Models, Theoretical; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents