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Cost effectiveness of option B plus for prevention of mother-to-child transmission of HIV in resource-limited countries: evidence from Kumasi, Ghana.

VanDeusen A, Paintsil E, Agyarko-Poku T, Long EF - BMC Infect. Dis. (2015)

Bottom Line: Modeled outcomes include HIV infections averted among newborn children, quality-adjusted life-years (QALYs), and cost-effectiveness ratios.HIV-infected women in Ghana have a lifetime average of 2.3 children (SD 1.3).Cost-effectiveness estimates remained favorable over robust sensitivity analyses.

View Article: PubMed Central - PubMed

Affiliation: Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA. avandeusen@gmail.com.

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.

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Related in: MedlinePlus

State transition model overview. A schematic diagram for the state transition model is given. Each oval represents a health state in which a woman can exist. She remains in a state for the period of time indicated underneath each oval. Each arrow represents a transition to the next state, which occurs with the probability indicated below each arrow.
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Fig1: State transition model overview. A schematic diagram for the state transition model is given. Each oval represents a health state in which a woman can exist. She remains in a state for the period of time indicated underneath each oval. Each arrow represents a transition to the next state, which occurs with the probability indicated below each arrow.

Mentions: We developed a state-transition model to calculate the average lifetime costs and health benefits associated with Option B+ or Option B (Figure 1). The model consists of several health states in which an HIV+ woman can exist, and transition probabilities that relate to the likelihood of moving to a different health state in the next time period. A woman remains in each state for a time unit of three months (a “cycle”), with the exception of the “Dead” state, in which a woman remains in this absorbing state.Figure 1


Cost effectiveness of option B plus for prevention of mother-to-child transmission of HIV in resource-limited countries: evidence from Kumasi, Ghana.

VanDeusen A, Paintsil E, Agyarko-Poku T, Long EF - BMC Infect. Dis. (2015)

State transition model overview. A schematic diagram for the state transition model is given. Each oval represents a health state in which a woman can exist. She remains in a state for the period of time indicated underneath each oval. Each arrow represents a transition to the next state, which occurs with the probability indicated below each arrow.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4374181&req=5

Fig1: State transition model overview. A schematic diagram for the state transition model is given. Each oval represents a health state in which a woman can exist. She remains in a state for the period of time indicated underneath each oval. Each arrow represents a transition to the next state, which occurs with the probability indicated below each arrow.
Mentions: We developed a state-transition model to calculate the average lifetime costs and health benefits associated with Option B+ or Option B (Figure 1). The model consists of several health states in which an HIV+ woman can exist, and transition probabilities that relate to the likelihood of moving to a different health state in the next time period. A woman remains in each state for a time unit of three months (a “cycle”), with the exception of the “Dead” state, in which a woman remains in this absorbing state.Figure 1

Bottom Line: Modeled outcomes include HIV infections averted among newborn children, quality-adjusted life-years (QALYs), and cost-effectiveness ratios.HIV-infected women in Ghana have a lifetime average of 2.3 children (SD 1.3).Cost-effectiveness estimates remained favorable over robust sensitivity analyses.

View Article: PubMed Central - PubMed

Affiliation: Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA. avandeusen@gmail.com.

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.

Show MeSH
Related in: MedlinePlus