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

Kuznik, Andreas; Lamorde, Mohammed; Hermans, Sabine; Castelnuovo, Barbara; Auerbach, Brandon J.; Semeere, Aggrey; Sempa, Joseph; Ssennono, Mark; Ssewankambo, Fred; Manabe, Yukari C.

doi:10.2471/blt.11.095430

Cited by 47 publications

(21 citation statements)

References 23 publications

(21 reference statements)

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“…As Option B+ is scaled up throughout SSA, healthcare systems must balance the additional costs of providing lifelong treatment to pregnant and breastfeeding women with prevention efforts to reduce LTFU (Ciaranello et al, 2013; Kuznik et al, 2012). Risk scores offer a simple and easy tool that can be employed at delivery, when women are still engaged in care, to identify women most likely to benefit from an intervention to reduce LTFU.…”

Section: Discussionmentioning

confidence: 99%

A risk score to identify HIV-infected women most likely to become lost to follow-up in the postpartum period

et al. 2016

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Access to lifelong combination antiretroviral therapy (cART) is expanding among HIV-infected pregnant and breastfeeding women throughout sub-Saharan Africa. For this strategy to meaningfully improve maternal HIV outcomes, retention in HIV care is essential. We developed a risk score to identify women with high likelihood of loss to follow-up (LTFU) at 6 months postpartum from HIV care, using data from public health facilities in Lusaka, Zambia. LTFU was defined as not presenting for HIV care within 60 days of the last scheduled appointment. We used logistic regression to assess demographic, obstetric, and HIV predictors of LTFU and to develop a simple risk score. Sensitivity and specificity were assessed at each risk score cut-point. Among 2,029 pregnant women initiating cART between 2009 and 2011, 507 (25%) were LTFU by 6 months postpartum. Parity, education, employment status, WHO clinical stage, duration of cART during pregnancy, and number of antenatal care visits were associated with LTFU (p-value<0.10). A risk score cut-point of 11 (42nd percentile) had 85% sensitivity (95% CI 82%, 88%) and 22% specificity (95% CI 20%, 24%) to detect women LTFU and would exclude 20% of women from a retention intervention. A risk score cut-point of 18 (69th percentile) identified the 23% of women with the highest probability of LTFU and had sensitivity 32% (95% CI 28%, 36%) and specificity 80% (95% CI 78%, 82%). A risk score approach may be useful to triage a subset of women most likely to be LTFU for targeted retention interventions.

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Section: Discussionmentioning

confidence: 99%

A risk score to identify HIV-infected women most likely to become lost to follow-up in the postpartum period

et al. 2016

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“…The ICER for this rapid ‘Xpert plus LF-LAM’ diagnostic intervention ($57/DALY-averted) compares favorably to other HIV-care interventions in Uganda such as combination ART for prevention of mother-to-child transmission ($46/DALY-averted) [19]. Importantly for policy makers, we showed that diagnostic costs associated with algorithms utilizing either LF-LAM or Xpert represent only a minority of total program costs for HIV patients with suspected TB.…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of novel algorithms for rapid diagnosis of tuberculosis in HIV-infected individuals in Uganda

Shah

Dowdy

Joloba³

et al. 2013

Aids

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Objective Xpert MTB/RIF (‘Xpert’) and urinary lateral-flow lipoarabinomannan (LF-LAM) assays offer rapid tuberculosis (TB) diagnosis. This study evaluated the cost-effectiveness of novel diagnostic algorithms utilizing combinations of Xpert and LF-LAM for the detection of active TB among people living with HIV. Design Cost-effectiveness analysis using data from a comparative study of LF-LAM and Xpert, with a target population of HIV-infected individuals with signs/symptoms of TB in Uganda. Methods A decision-analysis model compared multiple strategies for rapid TB diagnosis:sputum smear-microscopy; sputum Xpert; smear-microscopy combined with LF-LAM; and Xpert combined with LF-LAM. Primary outcomes were the costs and DALY’s averted for each algorithm. Cost-effectiveness was represented using incremental cost-effectiveness ratios (ICER). Results Compared with an algorithm of Xpert testing alone, the combination of Xpert with LF-LAM was considered highly cost-effective (ICER $57/DALY-averted) at a willingness to pay threshold of Ugandan GDP per capita. Addition of urine LF-LAM testing to smear-microscopy was a less effective strategy than Xpert replacement of smear-microscopy, but was less costly and also considered highly cost-effective (ICER $33 per DALY-averted) compared with continued usage of smear-microscopy alone. Cost-effectiveness of the Xpert plus LF-LAM algorithm was most influenced by HIV/ART costs and life-expectancy of patients after TB treatment. Conclusion The addition of urinary LF-LAM to TB diagnostic algorithms for HIV-infected individuals is highly cost-effective compared with usage of either sputum smear-microscopy or Xpert alone.

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“…In addition, three studies have examined Options B and B+ [44,46,58]. Our work in Zimbabwe suggests that Option B+ is cost-effective, when directly compared to Option B, with an ICER of $1,370/YLS [44].…”

Section: Economic Investments Necessary To Eliminate New Pediatric Himentioning

confidence: 99%

What is needed to eliminate new pediatric HIV infections

Doherty¹,

Ciaranello²

2013

Current Opinion in HIV and AIDS

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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.

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

Cited by 47 publications

References 23 publications

A risk score to identify HIV-infected women most likely to become lost to follow-up in the postpartum period

A risk score to identify HIV-infected women most likely to become lost to follow-up in the postpartum period

Cost-effectiveness of novel algorithms for rapid diagnosis of tuberculosis in HIV-infected individuals in Uganda

What is needed to eliminate new pediatric HIV infections

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