Cost-Effectiveness of Using HAART in Prevention of Mother-To-Child Transmission in the DREAM-Project Malawi

Orlando, Stefano; Marazzi, Maria Cristina; Liotta, Giuseppe; Ceffa, Susanna; Giglio, Pietro; Alumando, Ellard; Ziegler, Isabelle; Shawa, Mary; Palombi, Leonardo

doi:10.1097/qai.0b013e3181f9f9f5

Cited by 29 publications

(34 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the dream cohort, generalizing access to such an approach has led to virtual elimination of MTCT [10]. Option B is recommended without HIV RNA viral load as a prerequisite, but unfortunately many countries affected by generalized epidemic have not been able to opt for such an approach due to cost implications.…”

Section: Discussionmentioning

confidence: 99%

Virological profile of pregnant HIV positive women with high levels of CD4 count in low income settings: Can viral load help as eligibility criteria for maternal triple ARV prophylaxis (WHO 2010 option B)?

Nlend¹,

Ekobo²,

Moyo³

et al. 2011

Pan Afr Med Jrnl

View full text Add to dashboard Cite

Introduction The objective of the study was to determine HIV-1 RNA load profile during pregnancy and assess the eligibility for the maternal triple antiretroviral prophylaxis. It was an observational cohort of pregnant HIV positive women ignorant of antiretroviral therapy with CD4 cell count of>350/mm 3 Methods Routine CD4 cell count assessment in HIV positive pregnant women completed by non exclusive measurement of the viral load by PCR /ARN in those with CD4 cell count>350/mm 3 . Exclusion criteria: highly active antiretroviral therapy prior to pregnancy. Results Between January and December 2010, CD4 cell count was systematically performed in all pregnant women diagnosed as HIV-infected (n=266) in a referral center of 25 antenatal clinics. 63% (N=170) had CD4 cell count>350/mm 3 , median: 528 (IQR: 421–625). 145 underwent measurement of viral load by PCR/RNA at a median gestational of 23 weeks of pregnancy (IQR: 19–28). Median viral load 4.4log 10 /ml, IQR (3.5–4.9).19/145(13%) had an undetectable viral load of=1.8log 10 /ml. 89/145(61%) had a viral load of=4 log 10 /ml and were eligible for maternal triple ARV prophylaxis. Conclusion More than 6 in 10 pregnant HIV positive women with CD4 cell count of>350/mm 3 may require triple antiretroviral for prophylaxis of MTCT. Regardless of cost, such results are conclusive and may be considered in HIV high burden countries for universal access to triple antiretroviral prophylaxis in order to move towards virtual elimination of HIV MTCT.

show abstract

Section: Discussionmentioning

confidence: 99%

Virological profile of pregnant HIV positive women with high levels of CD4 count in low income settings: Can viral load help as eligibility criteria for maternal triple ARV prophylaxis (WHO 2010 option B)?

Nlend¹,

Ekobo²,

Moyo³

et al. 2011

Pan Afr Med Jrnl

View full text Add to dashboard Cite

show abstract

“…In Malawi, ART given for 10 months was associated with an incremental cost per DALY averted of US$ 35 (relative to no treatment). 29 In Nigeria, short-course ART initiated between weeks 14 and 24 of gestation and discontinued 6 weeks after delivery resulted in a cost per DALY averted of US$ 113 (relative to dual therapy during pregnancy and a single dose of nevirapine at delivery). 11 However, our work extends these findings by evaluating the impacts of a longer duration of breastfeeding, patient adherence and lifelong treatment on the relative cost-effectiveness of ART for PMTCT.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the cost-effectiveness of combination antiretroviral therapy for the prevention of mother-to-child transmission of HIV in Uganda

Kuznik

Lamorde

Hermans

et al. 2012

Bull World Health Org

View full text Add to dashboard Cite

“…To draw meaningful conclusions regarding the cost-effectiveness of alternative feeding approaches on the basis of the ICER, we determined the internationally-recommended willingness to pay (WTP) for health gains. Since the point at which an intervention becomes cost effective remains contested, we conservatively chose the US$50/DALY averted threshold used in similar studies in developing countries (Orlando et al 2010). Lifetime costs and DALYs were discounted (annual rate of 3%) to display the notion of time preference (Weinstein et al 1996).…”

Section: Estimating Cost-effectivenessmentioning

confidence: 99%

“…Critical issues addressed were: (i) effectiveness of all strategies using disabilityadjusted life years (DALYs) averted and HIV-free survival as outcomes; and (ii) feasibility and sustainability of each strategy from the health system perspective, measured as the costs of exercising each option. Whilst four studies have examined the cost-effectiveness of providing antiretroviral therapy (ART) or extended nevirapine prophylaxis (ENP) to breastfeeding HIV-infected women (Orlando et al 2010, Robberstad and Evjen-Olsen 2010, Shah et al 2011, Maclean and Stringer 2005, ours is the first study to compare formula feeding and breastfeeding with ENP in South Africa.…”

mentioning

confidence: 99%

Cost-effectiveness analysis of infant feeding strategies to prevent mother-to-child transmission of HIV in South Africa

Maredza

Bertram

Saloojee

et al. 2013

African Journal of AIDS Research

View full text Add to dashboard Cite

Despite increasing availability of perinatal interventions to prevent mother-to-child transmission (MTCT) of HIV in South Africa, MTCT remains high due to breastfeeding. To inform policy decisions in the country, cost-effectiveness of alternative infant-feeding interventions was conducted. Mathematical modelling was used to simulate post-natal transmission and mortality due to infant feeding in a hypothetical cohort of 1 000 HIV-exposed infants. Lifetime costs to the health system were calculated for each strategy. Interventions compared with current practice were: increasing coverage of extended nevirapine prophylaxis (ENP) to infants from 30% (base case) to 60% without changing current feeding practices; actively supporting breastfeeding with ENP to infants for 12 months; and actively supporting exclusive formula (replacement) feeding for 6 months. HIV-free survival at 24 months and disability-adjusted life years (DALYs) averted were estimated for typical rural and certain urban settings. Base-case analysis revealed that expanding coverage of nevirapine prophylaxis with breastfeeding is cost-saving and improves HIV-free survival. Changing feeding practices is beneficial, depending on context. Breastfeeding is dominant (less costly, more effective) in rural settings, whilst formula feeding is a dominant strategy in urban settings. Cost-effectiveness was most sensitive to proportion of women on lifelong antiretroviral therapy (ART) and infant mortality rate (IMR). When >55% of women are on ART, breastfeeding dominates in the urban settings modelled, whilst formula feeding is cost-effective in rural settings when IMR ≤ 45/1000. The study concludes that strategies to support breastfeeding are essential. Strengthening health systems is critical to ensure optimal nevirapine delivery during breastfeeding. A case can be made for formula feeding or breastfeeding in HIV-infected women in specific contexts.

show abstract

Cost-Effectiveness of Using HAART in Prevention of Mother-To-Child Transmission in the DREAM-Project Malawi

Abstract: Administration of HAART in a PMTCT programme in resource-limited settings is cost-effective. Drugs and laboratory tests are the most significant costs, but further reduction of these expenses is possible.

Cited by 29 publications

References 8 publications

Virological profile of pregnant HIV positive women with high levels of CD4 count in low income settings: Can viral load help as eligibility criteria for maternal triple ARV prophylaxis (WHO 2010 option B)?

Virological profile of pregnant HIV positive women with high levels of CD4 count in low income settings: Can viral load help as eligibility criteria for maternal triple ARV prophylaxis (WHO 2010 option B)?

Evaluating the cost-effectiveness of combination antiretroviral therapy for the prevention of mother-to-child transmission of HIV in Uganda

Cost-effectiveness analysis of infant feeding strategies to prevent mother-to-child transmission of HIV in South Africa

Contact Info

Product

Resources

About