[show abstract][hide abstract] ABSTRACT: To determine the net health consequences, costs, and cost-effectiveness of elective Cesarean delivery (C-section) to prevent perinatal transmission of hepatitis C virus (HCV) in HIV/HCV-coinfected women with suppressed HIV RNA but detectable HCV RNA.
Cost-effectiveness analysis using a probabilistic decision model.
The model compared two strategies: (i) C-section for all coinfected women with suppressed HIV RNA but detectable HCV RNA; (ii) C-section only when indicated based on fetal status. Outcomes included vertical transmission of HCV, maternal mortality, quality-adjusted life expectancy, delivery and HCV treatment costs, and incremental cost-effectiveness ratios. Data were obtained from the literature and national databases. Delivery cost data were from a hospital consortium database. Probability distributions were derived from published confidence intervals or estimated ranges, or calculated using reported sample sizes.
Elective C-section in coinfected women with suppressed HIV RNA but detectable HCV RNA would avoid 45 vertical HCV transmissions per 1000 deliveries and increase maternal mortality by one death per 100 000 deliveries. The incremental cost-effectiveness ratio of a recommendation for C-section versus current practice was 3900-6100 dollars per quality-adjusted life year for the mother-child pair. Results are sensitive to the efficacy of C-section in preventing transmission, the probability of vaginal delivery without a recommendation, and rates of maternal acceptance of the recommendation.
Assuming 2000 births/year among HIV/HCV-coinfected women in the United States, a recommendation for elective C-section in these women could avoid an additional 90 perinatal HCV transmissions per year with a risk of one maternal death in 50 years.
AIDS 10/2004; 18(13):1827-34. · 6.41 Impact Factor
[show abstract][hide abstract] ABSTRACT: In Thailand, since the first epidemics in 1958, there has been a global upward trend in incidence of Dengue Hemorrhagic Fever (DHF), an acute and severe form of dengue virus infection, which remains a major public health concern. The dengue is due to an arbovirus mainly transmitted by Aedes aegypti, a mosquito living close to human communities. The intensity of the transmission (i.e. number of cases and speed of the spread of the disease) is dependant on the number of vectors, the serotype of the virus, the herd immunity and the environment. In the Central Plain of Thailand despite an apparent very homogenous environment (altitude, climate, type of agriculture) the incidence of DHF exhibits strong variations at the province and sub-province levels. A Geographical Information System using epidemiological data, as well as information about the Land-use, demography, geography, climate has been built to identify indicators likely to help to describe areas and periods at risk for dengue transmission. A particular approach is focusing on the structure of the urban environment, the main field for dengue transmission. Different degrees and types of urbanisation appear to be linked to different intensities of dengue transmission. The main output of this study will be a method to describe areas at risk for high level of transmission and to forecast epidemic periods allowing a quick launch of dengue control activities. This study developed in the Central Plain of Thailand will be extended to other parts of the country and the same methods maybe applied to similar environments in other countries where the dengue is endemic.