OBJECTIVE: Nigeria has high rates of mother-to-child HIV transmission. We sought to determine whether new WHO recommendations for long-course antiretroviral therapy (ART) prophylaxis are cost-effective for prevention of mother-to-child transmission (PMTCT) of HIV compared to short-course strategies in Nigeria. DESIGN: We conducted a cost-effectiveness analysis from a health-system perspective, with a target population consisting of HIV-infected pregnant women in Nigeria. METHODS: A decision-analysis model compared two strategies for PMTCT: intervention – long-course maternal triple ART [zidovudine/lamivudine/efavirenz (ZDV/3TC/EFV)] beginning at 14 weeks gestation through the end of breastfeeding, with infant ART, per new WHO guidelines (option B); and minimal standard of care (MSOC) in Nigeria – short-course dual ART (ZDV/3TC) from 34 weeks gestation to 1 week postpartum, with single-dose nevirapine for infant and mother at labor/delivery. The primary outcomes were expected costs, pediatric HIV cases, and disability-adjusted life years (DALYs) accrued with each strategy; cost-effectiveness was represented using incremental cost-effectiveness ratios (ICERs). RESULTS: If implemented at the level of antenatal coverage in Nigeria (58%), mother-to-child HIV transmission could be reduced to 16.1% with MSOC and 12.8% with the intervention. At current pregnancy rates, the intervention would prevent 7680 infant HIV cases and avert 230 400 DALYs annually, compared to MSOC. The average health-system cost of the intervention was US$ 401 per pregnancy compared to $293 per pregnancy with MSOC. The intervention was associated with an ICER of $113 per-DALY-averted compared to MSOC, and was highly cost-effective using a willingness-to-pay threshold of per-capita Nigerian GDP. CONCLUSION: Implementation of new WHO recommendations for extended maternal and infant prophylaxis is highly cost-effective compared to short-course regimens for PMTCT of HIV in Nigeria.
OBJECTIVE: Nigeria has high rates of mother-to-child HIV transmission. We sought to determine whether new WHO recommendations for long-course antiretroviral therapy (ART) prophylaxis are cost-effective for prevention of mother-to-child transmission (PMTCT) of HIV compared to short-course strategies in Nigeria. DESIGN: We conducted a cost-effectiveness analysis from a health-system perspective, with a target population consisting of HIV-infected pregnant women in Nigeria. METHODS: A decision-analysis model compared two strategies for PMTCT: intervention – long-course maternal triple ART [zidovudine/lamivudine/efavirenz (ZDV/3TC/EFV)] beginning at 14 weeks gestation through the end of breastfeeding, with infant ART, per new WHO guidelines (option B); and minimal standard of care (MSOC) in Nigeria – short-course dual ART (ZDV/3TC) from 34 weeks gestation to 1 week postpartum, with single-dose nevirapine for infant and mother at labor/delivery. The primary outcomes were expected costs, pediatric HIV cases, and disability-adjusted life years (DALYs) accrued with each strategy; cost-effectiveness was represented using incremental cost-effectiveness ratios (ICERs). RESULTS: If implemented at the level of antenatal coverage in Nigeria (58%), mother-to-child HIV transmission could be reduced to 16.1% with MSOC and 12.8% with the intervention. At current pregnancy rates, the intervention would prevent 7680 infant HIV cases and avert 230 400 DALYs annually, compared to MSOC. The average health-system cost of the intervention was US$ 401 per pregnancy compared to $293 per pregnancy with MSOC. The intervention was associated with an ICER of $113 per-DALY-averted compared to MSOC, and was highly cost-effective using a willingness-to-pay threshold of per-capita Nigerian GDP. CONCLUSION: Implementation of new WHO recommendations for extended maternal and infant prophylaxis is highly cost-effective compared to short-course regimens for PMTCT of HIV in Nigeria.
Authors: Andreas Kuznik; Mohammed Lamorde; Sabine Hermans; Barbara Castelnuovo; Brandon Auerbach; Aggrey Semeere; Joseph Sempa; Mark Ssennono; Fred Ssewankambo; Yukari C Manabe Journal: Bull World Health Organ Date: 2012-08-01 Impact factor: 9.408
Authors: Luc E Coffeng; Wilma A Stolk; Honorat G M Zouré; J Lennert Veerman; Koffi B Agblewonu; Michele E Murdoch; Mounkaila Noma; Grace Fobi; Jan Hendrik Richardus; Donald A P Bundy; Dik Habbema; Sake J de Vlas; Uche V Amazigo Journal: PLoS Negl Trop Dis Date: 2013-01-31
Authors: Olufunke Fasawe; Carlos Avila; Nathan Shaffer; Erik Schouten; Frank Chimbwandira; David Hoos; Olive Nakakeeto; Paul De Lay Journal: PLoS One Date: 2013-03-12 Impact factor: 3.240