Journal article
Cost effectiveness of single-dose nevirapine regimen for mothers and babies to decrease vertical HIV-1 transmission in sub-Saharan Africa
The Lancet (British edition), Vol.354(9181), pp.803-809
09/04/1999
DOI: 10.1016/S0140-6736(99)80009-9
PMID: 10485721
Abstract
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.
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.
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.
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.
Details
- Title: Subtitle
- Cost effectiveness of single-dose nevirapine regimen for mothers and babies to decrease vertical HIV-1 transmission in sub-Saharan Africa
- Creators
- Elliot Marseille - Health Strategies International, 2 Madrone Place, Orinda, CA 94563, USAJames G Kahn - Institute for Health Policy Studies, Department of Epidemiology and Biostatistics, Center for AIDS Prevention Studies and AIDS Research Institute, University of California, San Francisco, CA, USAFrancis Mmiro - Department of Obstetrics and Gynaecology, Makerere University, Kampala, UgandaLaura Guay - Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USAPhilippa Musoke - Department of Paediatrics, Makerere University, KampalaMary Glenn Fowler - HIV/AIDS Branch, Centers for Disease Control and Prevention, Atlanta, GA, USAJ Brooks Jackson - Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Resource Type
- Journal article
- Publication Details
- The Lancet (British edition), Vol.354(9181), pp.803-809
- Publisher
- Elsevier Ltd
- DOI
- 10.1016/S0140-6736(99)80009-9
- PMID
- 10485721
- ISSN
- 0140-6736
- eISSN
- 1474-547X
- Language
- English
- Date published
- 09/04/1999
- Academic Unit
- Pathology; VPMA - Administration
- Record Identifier
- 9984047742102771
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