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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

One-way sensitivity analyses. Each graph indicates the change in the incremental cost-effectiveness ratio (ICER) between Option B and Option B+ when a single variable’s value is changed. The “base case” scenario is indicated with a circle. A downward-sloping line indicates Option B+ is becoming more cost-effective as the variable’s value is increased, while an upward-sloping line indicates Option B+ is becoming less cost-effective as the variable’s value is increased. The curve of each line indicates the specific rate at which the ICER changes as the variable’s value is altered.
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Fig4: One-way sensitivity analyses. Each graph indicates the change in the incremental cost-effectiveness ratio (ICER) between Option B and Option B+ when a single variable’s value is changed. The “base case” scenario is indicated with a circle. A downward-sloping line indicates Option B+ is becoming more cost-effective as the variable’s value is increased, while an upward-sloping line indicates Option B+ is becoming less cost-effective as the variable’s value is increased. The curve of each line indicates the specific rate at which the ICER changes as the variable’s value is altered.

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)

One-way sensitivity analyses. Each graph indicates the change in the incremental cost-effectiveness ratio (ICER) between Option B and Option B+ when a single variable’s value is changed. The “base case” scenario is indicated with a circle. A downward-sloping line indicates Option B+ is becoming more cost-effective as the variable’s value is increased, while an upward-sloping line indicates Option B+ is becoming less cost-effective as the variable’s value is increased. The curve of each line indicates the specific rate at which the ICER changes as the variable’s value is altered.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig4: One-way sensitivity analyses. Each graph indicates the change in the incremental cost-effectiveness ratio (ICER) between Option B and Option B+ when a single variable’s value is changed. The “base case” scenario is indicated with a circle. A downward-sloping line indicates Option B+ is becoming more cost-effective as the variable’s value is increased, while an upward-sloping line indicates Option B+ is becoming less cost-effective as the variable’s value is increased. The curve of each line indicates the specific rate at which the ICER changes as the variable’s value is altered.
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