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The cost-effectiveness of preventing mother-to-child transmission of HIV in low- and middle-income countries: systematic review.

Johri M, Ako-Arrey D - Cost Eff Resour Alloc (2011)

Bottom Line: Articles reporting full economic evaluations of interventions to prevent or reduce HIV MTCT were eligible for inclusion.Collectively, the articles suggest that interventions to prevent paediatric infections are cost-effective in a variety of LMIC settings as measured against accepted international benchmarks.In concentrated epidemics where HIV prevalence in the general population is very low, MTCT strategies based on universal testing of pregnant women may not compare well against cost-effectiveness benchmarks, or may satisfy formal criteria for cost-effectiveness but offer a low relative value as compared to competing interventions to improve population health.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Health Administration, Faculty of Medicine, University of Montreal, Quebec, Canada. mira.johri@umontreal.ca.

ABSTRACT

Background: Although highly effective prevention interventions exist, the epidemic of paediatric HIV continues to challenge control efforts in resource-limited settings. We reviewed the cost-effectiveness of interventions to prevent mother-to-child transmission (MTCT) of HIV in low- and middle-income countries (LMICs). This article presents syntheses of evidence on the costs, effects and cost-effectiveness of HIV MTCT strategies for LMICs from the published literature and evaluates their implications for policy and future research.

Methods: Candidate studies were identified through a comprehensive database search including PubMed, Embase, Cochrane Library, and EconLit restricted by language (English or French), date (January 1st, 1994 to January 17th, 2011) and article type (original research). Articles reporting full economic evaluations of interventions to prevent or reduce HIV MTCT were eligible for inclusion. We searched article bibliographies to identify additional studies. Two authors independently assessed eligibility and extracted data from studies retained for review. Study quality was appraised using a modified BMJ checklist for economic evaluations. Data were synthesised in narrative form.

Results: We identified 19 articles published in 9 journals from 1996 to 2010, 16 concerning sub-Saharan Africa. Collectively, the articles suggest that interventions to prevent paediatric infections are cost-effective in a variety of LMIC settings as measured against accepted international benchmarks. In concentrated epidemics where HIV prevalence in the general population is very low, MTCT strategies based on universal testing of pregnant women may not compare well against cost-effectiveness benchmarks, or may satisfy formal criteria for cost-effectiveness but offer a low relative value as compared to competing interventions to improve population health.

Conclusions and recommendations: Interventions to prevent HIV MTCT are compelling on economic grounds in many resource-limited settings and should remain at the forefront of global HIV prevention efforts. Future cost-effectiveness analyses can help to ensure that pMTCT interventions for LMICs reach their full potential by focussing on unanswered questions in four areas: local assessment of rapidly evolving HIV MTCT options; strategies to improve coverage and reach underserved populations; evaluation of a more comprehensive set of MTCT approaches including primary HIV prevention and reproductive counselling; integration of HIV MTCT and other sexual and reproductive health services.

No MeSH data available.


Related in: MedlinePlus

Study Quality. Limitations were assessed using a modified version of the BMJ quality assessment checklist for the conduct and reporting of cost-effectiveness studies [16]. A higher score reflects poorer quality.
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Related In: Results  -  Collection

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Figure 2: Study Quality. Limitations were assessed using a modified version of the BMJ quality assessment checklist for the conduct and reporting of cost-effectiveness studies [16]. A higher score reflects poorer quality.

Mentions: Study quality as assessed by the BMJ checklist was poor. The number of methodological limitations in the 19 articles ranged from one to seven, and eleven studies had four limitations or more[Figure 2]. Several studies did not present the economic model adequately or did not clearly explain how outcomes were calculated. Many studies did not report potential conflicts of interest or funding source; however, those that did reported funding from not-for-profit sources.


The cost-effectiveness of preventing mother-to-child transmission of HIV in low- and middle-income countries: systematic review.

Johri M, Ako-Arrey D - Cost Eff Resour Alloc (2011)

Study Quality. Limitations were assessed using a modified version of the BMJ quality assessment checklist for the conduct and reporting of cost-effectiveness studies [16]. A higher score reflects poorer quality.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3045936&req=5

Figure 2: Study Quality. Limitations were assessed using a modified version of the BMJ quality assessment checklist for the conduct and reporting of cost-effectiveness studies [16]. A higher score reflects poorer quality.
Mentions: Study quality as assessed by the BMJ checklist was poor. The number of methodological limitations in the 19 articles ranged from one to seven, and eleven studies had four limitations or more[Figure 2]. Several studies did not present the economic model adequately or did not clearly explain how outcomes were calculated. Many studies did not report potential conflicts of interest or funding source; however, those that did reported funding from not-for-profit sources.

Bottom Line: Articles reporting full economic evaluations of interventions to prevent or reduce HIV MTCT were eligible for inclusion.Collectively, the articles suggest that interventions to prevent paediatric infections are cost-effective in a variety of LMIC settings as measured against accepted international benchmarks.In concentrated epidemics where HIV prevalence in the general population is very low, MTCT strategies based on universal testing of pregnant women may not compare well against cost-effectiveness benchmarks, or may satisfy formal criteria for cost-effectiveness but offer a low relative value as compared to competing interventions to improve population health.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Health Administration, Faculty of Medicine, University of Montreal, Quebec, Canada. mira.johri@umontreal.ca.

ABSTRACT

Background: Although highly effective prevention interventions exist, the epidemic of paediatric HIV continues to challenge control efforts in resource-limited settings. We reviewed the cost-effectiveness of interventions to prevent mother-to-child transmission (MTCT) of HIV in low- and middle-income countries (LMICs). This article presents syntheses of evidence on the costs, effects and cost-effectiveness of HIV MTCT strategies for LMICs from the published literature and evaluates their implications for policy and future research.

Methods: Candidate studies were identified through a comprehensive database search including PubMed, Embase, Cochrane Library, and EconLit restricted by language (English or French), date (January 1st, 1994 to January 17th, 2011) and article type (original research). Articles reporting full economic evaluations of interventions to prevent or reduce HIV MTCT were eligible for inclusion. We searched article bibliographies to identify additional studies. Two authors independently assessed eligibility and extracted data from studies retained for review. Study quality was appraised using a modified BMJ checklist for economic evaluations. Data were synthesised in narrative form.

Results: We identified 19 articles published in 9 journals from 1996 to 2010, 16 concerning sub-Saharan Africa. Collectively, the articles suggest that interventions to prevent paediatric infections are cost-effective in a variety of LMIC settings as measured against accepted international benchmarks. In concentrated epidemics where HIV prevalence in the general population is very low, MTCT strategies based on universal testing of pregnant women may not compare well against cost-effectiveness benchmarks, or may satisfy formal criteria for cost-effectiveness but offer a low relative value as compared to competing interventions to improve population health.

Conclusions and recommendations: Interventions to prevent HIV MTCT are compelling on economic grounds in many resource-limited settings and should remain at the forefront of global HIV prevention efforts. Future cost-effectiveness analyses can help to ensure that pMTCT interventions for LMICs reach their full potential by focussing on unanswered questions in four areas: local assessment of rapidly evolving HIV MTCT options; strategies to improve coverage and reach underserved populations; evaluation of a more comprehensive set of MTCT approaches including primary HIV prevention and reproductive counselling; integration of HIV MTCT and other sexual and reproductive health services.

No MeSH data available.


Related in: MedlinePlus