Abstract
BackgroundThe Ministry of Health in Malawi is implementing a pragmatic and innovative approach for the management of all HIV-infected pregnant women, termed Option B+, which consists of providing life-long antiretroviral treatment, regardless of their CD4 count or clinical stage. Our objective was to determine if Option B+ represents a cost-effective option.MethodsA decision model simulates the disease progression of a cohort of HIV-infected pregnant women receiving prophylaxis and antiretroviral therapy, and estimates the number of paediatric infections averted and maternal life years gained over a ten-year time horizon. We assess the cost-effectiveness from the Ministry of Health perspective while taking into account the practical realities of implementing ART services in Malawi.ResultsIf implemented as recommended by the World Health Organization, options A, B and B+ are equivalent in preventing new infant infections, yielding cost effectiveness ratios between US$ 37 and US$ 69 per disability adjusted life year averted in children. However, when the three options are compared to the current practice, the provision of antiretroviral therapy to all mothers (Option B+) not only prevents infant infections, but also improves the ten-year survival in mothers more than four-fold. This translates into saving more than 250,000 maternal life years, as compared to mothers receiving only Option A or B, with savings of 153,000 and 172,000 life years respectively. Option B+ also yields favourable incremental cost effectiveness ratios (ICER) of US$ 455 per life year gained over the current practice.ConclusionIn Malawi, Option B+ represents a favorable policy option from a cost-effectiveness perspective to prevent future infant infections, save mothers' lives and reduce orphanhood. Although Option B+ would require more financial resources initially, it would save societal resources in the long-term and represents a strategic option to simplify and integrate HIV services into maternal, newborn and child health programmes.
Highlights
HIV continues to pose a serious health risk for pregnant women and their children in high prevalence settings
We modelled the mix of interventions in Malawi including HIV testing and counselling and ARV prophylaxis for HIV-infected pregnant women at the reported coverage levels as of the end of 2010 [2].We modelled an ante-natal care (ANC) coverage of 91% according to the World Health Statistics report
We assessed the cost-effectiveness of the 2010 World Health Organization (WHO) mother-tochild transmission prevention strategies: Options A and B, and Malawi’s Option B+
Summary
HIV continues to pose a serious health risk for pregnant women and their children in high prevalence settings. An estimated 390 000 children globally acquired HIV from their mothers in 2010 with over 90% of these new infections occurring in sub-Saharan Africa [2]. The use of antiretroviral drugs during and after pregnancy is a proven intervention to virtually eliminate the risk of HIV transmission to infants, as evidenced in high-income countries where new childhood HIV infections are almost non-existent [4,5]. The Ministry of Health in Malawi is implementing a pragmatic and innovative approach for the management of all HIV-infected pregnant women, termed Option B+, which consists of providing life-long antiretroviral treatment, regardless of their CD4 count or clinical stage. Our objective was to determine if Option B+ represents a cost-effective option
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