title: Option B+ for the prevention of mother-to-child transmission of HIV infection in developing countries: a review of published cost-effectiveness analyses.
abstract: OBJECTIVE
  To review the published literature on the cost effectiveness of Option B+ (lifelong antiretroviral therapy) for preventing mother-to-child transmission (PMTCT) of HIV during pregnancy and breastfeeding to inform decision making in low- and middle-income countries.
  
  
  METHODS
  PubMed, Scopus, Google scholar and Medline were searched to identify studies of the cost effectiveness of the World Health Organization (WHO) treatment guidelines for PMTCT. Study quality was appraised using the consolidated health economic evaluation reporting standards checklist. Eligible studies were reviewed in detail to assess the relevance and impact of alternative evaluation frameworks, assumptions and input parameter values.
  
  
  RESULTS
  Five published cost effectiveness analyses of Option B+ for the PMTCT of HIV were identified. The reported cost-effectiveness of Option B+ varies substantially, with the results of different studies implying that Option B+ is dominant (lower costs, greater benefits), cost-effective (additional benefits at acceptable additional costs) or not cost-effective (additional benefits at unacceptable additional costs). This variation is due to significant differences in model structures and input parameter values. Structural differences were observed around the estimation of programme effects on infants, HIV-infected mothers and their HIV negative partners, over multiple pregnancies, as well assumptions regarding routine access to antiretroviral therapies. Significant differences in key input parameters were observed in transmission rates, intervention costs and effects and downstream cost savings.
  
  
  CONCLUSIONS
  Across five model-based cost-effectiveness analyses of strategies for the PMTCT of HIV, the most comprehensive analysis reported that option B+ is highly likely to be cost-effective. This evaluation may have been overly favourable towards option B+ with respect to some input parameter values, but potentially important additional benefits were omitted. Decision makers might be best advised to review this analysis, with a view to requesting additional analyses of the model to inform local funding decisions around alternative strategies for the PMTCT of HIV.
authors.affiliation: School of Public Health, University of Adelaide, Australia jonathan.karnon@adelaide.edu.au.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Karnon
authors.affiliation: and Department of Health Planning, Research and Statistics, Federal Ministry of Health, Nigeria.
authors.forename: Nneka
authors.initials: N
authors.lastname: Orji
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000191:economics*; D001942:Breast Feeding; D002648:Child; D003362:Cost-Benefit Analysis / Q000191:economics*; D003906:Developing Countries; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics* / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000191:economics / Q000517:prevention & control*; D009035:Mothers; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control; D014944:World Health Organization
chemical_list: D019380:Anti-HIV Agents
keywords: Mother-to-child transmission; WHO; cost-effectiveness; developing countries; low-income; middle-income; option B; prevention