Abstract
BackgroundAlthough Option B+ may be more costly than Options B, it may provide additional health benefits that are currently unclear in Yunnan province. We created deterministic models to estimate the cost-effectiveness of Option B+.MethodsData were used in two deterministic models simulating a cohort of 2000 HIV+ pregnant women. A decision tree model simulated the number of averted infants infections and QALY acquired for infants in the PMTCT period for Options B and B+. The minimum cost was calculated. A Markov decision model simulated the number of maternal life year gained and serodiscordant partner infections averted in the ten years after PMTCT for Option B or B+. ICER per life year gained was calculated. Deterministic sensitivity analyses were conducted.ResultsIf fully implemented, Option B and Option B+ averted 1016.85 infections and acquired 588,01.02 QALYs.The cost of Option B was US$1,229,338.47, the cost of Option B+ was 1,176,128.63. However, when Options B and B+ were compared over ten years, Option B+ not only improved mothers’ten-year survival from 69.7 to 89.2%, saving more than 3890 life-years, but also averted 3068 HIV infections between serodiscordant partners. Option B+ yielded a favourable ICER of $32.99per QALY acquired in infants and $5149per life year gained in mothers. A 1% MTCT rate, a 90% coverage rate and a 20-year horizon could decrease the ICER per QALY acquired in children and LY gained in mothers.ConclusionsOption B+ is a cost-effective treatment for comprehensive HIV prevention for infants and serodiscordant partners and life-long treatment for mothers in Yunnan province, China. Option B+ could be implemented in Yunnan province, especially as the goals of elimination mother-to-child transmission of HIV and “90–90-90” achieved, Option B+ would be more attractive.
Highlights
Option B+ may be more costly than Options B, it may provide additional health benefits that are currently unclear in Yunnan province
Studies indicate the incremental cost of switching from Option B to Option B+ in prevention of mother-to-child transmission (PMTCT) programs ranged from US dollars (US$)92,813 to US$605,739 per 1000 women [10] and the Incremental cost-effectiveness ratio (ICER) was US$1370 per year of life saved compared with Option B [3] and ranged from US$6000 to US$23,000 per infection averted compared with Option A [6]
The most analyses have identified the likely cost-effective of Option B+, a recent review of published cost-effectiveness analyses of Option B+ for prevention of mother-to-child transmission of HIV in developing countries demonstrated whether Option B+ was dominant, cost-effective or non cost-effective depended on the differences of the decision model structure and input parameter values
Summary
Option B+ may be more costly than Options B, it may provide additional health benefits that are currently unclear in Yunnan province. We created deterministic models to estimate the cost-effectiveness of Option B+. The recommendations of the World Health Organization (WHO) on the prevention of mother-to-child transmission (PMTCT) of HIV infection have evolved significantly over time. Studies indicate the incremental cost of switching from Option B to Option B+ in PMTCT programs ranged from US$92,813 to US$605,739 per 1000 women [10] and the Incremental cost-effectiveness ratio (ICER) was US$1370 per year of life saved compared with Option B [3] and ranged from US$6000 to US$23,000 per infection averted compared with Option A [6]. The most analyses have identified the likely cost-effective of Option B+, a recent review of published cost-effectiveness analyses of Option B+ for prevention of mother-to-child transmission of HIV in developing countries demonstrated whether Option B+ was dominant, cost-effective or non cost-effective depended on the differences of the decision model structure and input parameter values. Decision makers still need additional analyses of model to inform the local funding decision [11]
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