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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

Probability distribution of time between 1stand 2ndpregnancy. The fraction of women (n = 817) who wait a given number of years between their first and second pregnancy is shown, with the number of years indicated on the x-axis and the proportion of women indicated on the y-axis. “0 years” indicates that the mother had only one child.
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Fig2: Probability distribution of time between 1stand 2ndpregnancy. The fraction of women (n = 817) who wait a given number of years between their first and second pregnancy is shown, with the number of years indicated on the x-axis and the proportion of women indicated on the y-axis. “0 years” indicates that the mother had only one child.

Mentions: Based on medical chart review, a probability hazard function was fit to estimate the rate of future pregnancies following the first pregnancy (Figure 2). Each pregnancy recorded from the chart review was considered an event and the age at which these events occurred was included in the model. This hazard model then produced the probability of a subsequent pregnancy occurring at each age in a woman’s lifetime. The model was developed in SAS 9.3.Figure 2


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)

Probability distribution of time between 1stand 2ndpregnancy. The fraction of women (n = 817) who wait a given number of years between their first and second pregnancy is shown, with the number of years indicated on the x-axis and the proportion of women indicated on the y-axis. “0 years” indicates that the mother had only one child.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Probability distribution of time between 1stand 2ndpregnancy. The fraction of women (n = 817) who wait a given number of years between their first and second pregnancy is shown, with the number of years indicated on the x-axis and the proportion of women indicated on the y-axis. “0 years” indicates that the mother had only one child.
Mentions: Based on medical chart review, a probability hazard function was fit to estimate the rate of future pregnancies following the first pregnancy (Figure 2). Each pregnancy recorded from the chart review was considered an event and the age at which these events occurred was included in the model. This hazard model then produced the probability of a subsequent pregnancy occurring at each age in a woman’s lifetime. The model was developed in SAS 9.3.Figure 2

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