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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

Sensitivity analysis of model variables. This tornado diagram represents the sensitivity of different variables included in the model. Each variable is listed, along with the associated incremental cost-effectiveness ratio (ICER). The horizontal width of each bar represents the change in cost-effectiveness of Option B+ versus Option B ($/QALY gained) as each model parameter is varied over the range given in parentheses. Variables are listed in descending sensitivity; those whose ICER values change most significantly are listed first. For reference, a vertical line indicating the Ghanaian GDP per capita is included on the graph, which demonstrates that Option B+ is a cost-effective alternative, even across a wide range of sensitivity analyses. The base case ICER value is $785/QALY gained.
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Fig3: Sensitivity analysis of model variables. This tornado diagram represents the sensitivity of different variables included in the model. Each variable is listed, along with the associated incremental cost-effectiveness ratio (ICER). The horizontal width of each bar represents the change in cost-effectiveness of Option B+ versus Option B ($/QALY gained) as each model parameter is varied over the range given in parentheses. Variables are listed in descending sensitivity; those whose ICER values change most significantly are listed first. For reference, a vertical line indicating the Ghanaian GDP per capita is included on the graph, which demonstrates that Option B+ is a cost-effective alternative, even across a wide range of sensitivity analyses. The base case ICER value is $785/QALY gained.

Mentions: A tornado diagram (Figure 3) shows that the cost-effectiveness of Option B+ was also sensitive to life expectancies, disease transmission probabilities, access to antenatal care, and fertility rates. One-way sensitivity analyses of several variables display each variable’s relationship to the ICER value (Figure 4). In general, as the probability of accessing antenatal care changes from 50% to 95%, Option B+ becomes more cost-effective because future children are more likely to avoid HIV infection. Conversely, as maternal life expectancy on Option B increases, the cost-effectiveness of Option B+ worsens because the marginal gain in QALYs resulting from Option B+ diminishes.Figure 3


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)

Sensitivity analysis of model variables. This tornado diagram represents the sensitivity of different variables included in the model. Each variable is listed, along with the associated incremental cost-effectiveness ratio (ICER). The horizontal width of each bar represents the change in cost-effectiveness of Option B+ versus Option B ($/QALY gained) as each model parameter is varied over the range given in parentheses. Variables are listed in descending sensitivity; those whose ICER values change most significantly are listed first. For reference, a vertical line indicating the Ghanaian GDP per capita is included on the graph, which demonstrates that Option B+ is a cost-effective alternative, even across a wide range of sensitivity analyses. The base case ICER value is $785/QALY gained.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig3: Sensitivity analysis of model variables. This tornado diagram represents the sensitivity of different variables included in the model. Each variable is listed, along with the associated incremental cost-effectiveness ratio (ICER). The horizontal width of each bar represents the change in cost-effectiveness of Option B+ versus Option B ($/QALY gained) as each model parameter is varied over the range given in parentheses. Variables are listed in descending sensitivity; those whose ICER values change most significantly are listed first. For reference, a vertical line indicating the Ghanaian GDP per capita is included on the graph, which demonstrates that Option B+ is a cost-effective alternative, even across a wide range of sensitivity analyses. The base case ICER value is $785/QALY gained.
Mentions: A tornado diagram (Figure 3) shows that the cost-effectiveness of Option B+ was also sensitive to life expectancies, disease transmission probabilities, access to antenatal care, and fertility rates. One-way sensitivity analyses of several variables display each variable’s relationship to the ICER value (Figure 4). In general, as the probability of accessing antenatal care changes from 50% to 95%, Option B+ becomes more cost-effective because future children are more likely to avoid HIV infection. Conversely, as maternal life expectancy on Option B increases, the cost-effectiveness of Option B+ worsens because the marginal gain in QALYs resulting from Option B+ diminishes.Figure 3

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