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Abstract: Cost-Effectiveness
of Single-Dose Nevirapine Regimen for Mothers and Babies to Decrease Vertical
HIV-1 Transmission in Sub-Saharan Africa. Marseille E*, Kahn JG, Mmiro F, Guay L, Musoke P,
Fowler MG, Jackson JB. |
Background:
Identification of economical interventions to decrease HIV-1 transmission to children is an urgent public-health priority in sub-Saharan
Africa. We assessed the cost effectiveness of the
HIVNET 012 nevirapine regimen
Methods:
We assessed cost effectiveness in a hypothetical cohort of 20,000 pregnant women
in sub-Saharan Africa. Our main outcome measures were programme cost, paediatric
HIV-1 cases averted, cost per case averted, and cost per disability-adjusted
life-year (DALY). We compared HIVNET 012 with other short-course antiretroviral
regimens. We also compared two implementation strategies: counselling and HIV-1
testing before treatment (targeted treatment), or nevirapine for all pregnant
women (universal treatment, no counselling and testing). We did univariate and
multivariate sensitivity analyses.
Findings:
For universal treatment with 30% HIV-1 seroprevalence, the HIVNET 012 regimen
would avert 603 cases of HIV-1 in babies, cost US$83,333, and generate 15,862
DALYs. The associated cost-effectiveness ratios were $138 per case averted or
$5.25 per DALY. At 15% seroprevalence, the universal treatment option would cost
$83,333 and avert 302 cases at $276 per case averted or $10.51 per DALY. For
targeted treatment at 30% seroprevalence, HIVNET 012 would cost $141,922 and
avert 476 cases at $298 per case averted or $11.29 per DALY. With seroprevalence
higher than 3.0% for universal and 4.5% for targeted treatment, the HIVNET 012
regimen was likely to be as cost effective as other public-health interventions.
The cost effectiveness of HIVNET 012 was robust under a wide range of parameters
in the sensitivity analysis.
Interpretation: The HIVNET 012 regimen can be highly cost-effective in high seroprevalence settings. In lower seroprevalence areas, when multidose regimens are not cost effective, nevirapine therapy could have a major public-health impact at a reasonable cost.
*Health Strategies International, Orinda, CA 94563, USA. emarseille@home.com
