Cost-effectiveness and cost-benefit in the prevention of mother-to-child transmission of HIV in developing countries

Abstract

Approximately 25-30% of infants born to HIV-infected mothers in developing countries are infected with HIV. A range of approaches exists to reduce the rate of mother-to-child transmission (MCT). Currently however the only therapeutic approach proven to reduce such vertical transmission is the administration of zidovudine therapy during pregnancy delivery and the neonatal period in the absence of breast-feeding. The authors review economic evaluation as an approach to help guide the development of policies on preventing MCT in developing countries drawing from studies evaluating anti-retroviral therapy in sub-Saharan Africa and Thailand. Principles of economic evaluation are discussed followed by a review of available evidence and the consideration of the sensitivity of estimates to parameter variation the reliability of parameter estimates model completeness and comparability and affordability. Future evaluations of MCT interventions should include economic evaluation to determine whether the intervention if found to be effective can or should be implemented as a public health measure. Such economic evaluations should be clear and include a sensitivity analysis of the most important variables thought to influence effectiveness and costs. Affordability should also be considered and multiple outcome measures and frames of reference used.