Article

Cost-Effectiveness Analysis of Option B+ for HIV Prevention and Treatment of Mothers and Children in Malawi

Master of International Health Management, Economics and Policy Program, SDA Bocconi School of Management, Milan, Italy.
PLoS ONE (Impact Factor: 3.53). 03/2013; DOI: 10.1371/journal.pone.0057778

ABSTRACT The Ministry of Health in Malawi is implementing a pragmatic and innovative approach for the management of all HIV-infected pregnant women, termed Option B+, which consists of providing life-long antiretroviral treatment, regardless of their CD4 count or clinical stage. Our objective was to determine if Option B+ represents a cost-effective option.
A decision model simulates the disease progression of a cohort of HIV-infected pregnant women receiving prophylaxis and antiretroviral therapy, and estimates the number of paediatric infections averted and maternal life years gained over a ten-year time horizon. We assess the cost-effectiveness from the Ministry of Health perspective while taking into account the practical realities of implementing ART services in Malawi.
If implemented as recommended by the World Health Organization, options A, B and B+ are equivalent in preventing new infant infections, yielding cost effectiveness ratios between US$ 37 and US$ 69 per disability adjusted life year averted in children. However, when the three options are compared to the current practice, the provision of antiretroviral therapy to all mothers (Option B+) not only prevents infant infections, but also improves the ten-year survival in mothers more than four-fold. This translates into saving more than 250,000 maternal life years, as compared to mothers receiving only Option A or B, with savings of 153,000 and 172,000 life years respectively. Option B+ also yields favourable incremental cost effectiveness ratios (ICER) of US$ 455 per life year gained over the current practice.
In Malawi, Option B+ represents a favorable policy option from a cost-effectiveness perspective to prevent future infant infections, save mothers' lives and reduce orphanhood. Although Option B+ would require more financial resources initially, it would save societal resources in the long-term and represents a strategic option to simplify and integrate HIV services into maternal, newborn and child health programmes.

Download full-text

Full-text

Available from: Carlos Avila, Jun 30, 2015
0 Followers
 · 
138 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE OF REVIEW: Computer simulation models can identify key clinical, operational, and economic interventions that will be needed to achieve the elimination of new pediatric HIV infections. In this review, we summarize recent findings from model-based analyses of strategies for prevention of mother-to-child HIV transmission (MTCT). RECENT FINDINGS: In order to achieve elimination of MTCT (eMTCT), model-based studies suggest that scale-up of services will be needed in several domains: uptake of services and retention in care (the PMTCT 'cascade'), interventions to prevent HIV infections in women and reduce unintended pregnancies (the 'four-pronged approach'), efforts to support medication adherence through long periods of pregnancy and breastfeeding, and strategies to make breastfeeding safer and/or shorter. Models also project the economic resources that will be needed to achieve these goals in the most efficient ways to allocate limited resources for eMTCT. Results suggest that currently recommended PMTCT regimens (WHO Option A, Option B, and Option B+) will be cost-effective in most settings. SUMMARY: Model-based results can guide future implementation science, by highlighting areas in which additional data are needed to make informed decisions and by outlining critical interventions that will be necessary in order to eliminate new pediatric HIV infections.
    Current opinion in HIV and AIDS 06/2013; DOI:10.1097/COH.0b013e328362db0d · 4.39 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The development of potent drugs for the control of viraemia in people living with HIV means that infected people may live a normal, healthy life and offers the prospect of eliminating HIV transmission in the short term and HIV infection in the long term. Other interventions, including the use of condoms, pre-exposure prophylaxis, treatment of sexually transmitted infections and behaviour change programmes, may also be effective in reducing HIV transmission to varying degrees. Here we examine recommendations for when to start treatment with anti-retroviral drugs, estimate the impact that treatment may have on HIV transmission in the short and in the long term, and compare the impact and cost of treatment with that of other methods of control. We focus on generalized HIV epidemics in sub-Saharan Africa. We show that universal access to ART combined with early treatment is the most effective and, in the long term, the most cost-effective intervention. Elimination will require effective coverage of about 80% or more but treatment is effective and cost effective even at low levels of coverage. Other interventions may provide important support to a programme of early treatment in particular groups. Condoms provide protection for both men and women and should be readily available whenever they are needed. Medical male circumcision will provide a degree of immediate protection for men and microbicides will do the same for women. Behaviour change programmes in themselves are unlikely to have a significant impact on overall transmission but may play a critical role in supporting early treatment through helping to avoid stigma and discrimination, ensuring the acceptability of testing and early treatment as well as compliance.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Considerable debate has emerged on whether Option B+ (B+), initiation of lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women, is the best approach to achieving elimination of mother-to-child-transmission. However, direct evidence and experience with B+ is limited. We review the current evidence informing the proposed benefits and potential risks of the B+ approach, distinguishing individual health concerns for mother and child from program delivery and public health issues. For mothers and infants, B+ may offer significant benefits for transmission prevention and maternal health. However, several studies raise concerns about the safety of ART exposure to fetuses and infants, as well as adherence challenges for pregnant and breastfeeding mothers. For program delivery and public health, B+ presents distinct advantages in terms of transmission prevention to uninfected partners and increased simplicity potentially improving program feasibility, access, uptake, and retention in care. Despite being more costly in the short-term, B+ will likely be cost effective over time. This review provides a detailed analysis of risks and benefits of B+. As national programs adopt this approach, it will be critical to carefully assess both short-term and long-term maternal and infant outcomes.
    Current opinion in HIV and AIDS 09/2013; 8(5):473-88. DOI:10.1097/COH.0b013e328363a8f2 · 4.39 Impact Factor