Abstract
ObjectivesBased on the important changes in South Africa since 2009 and the Antiretroviral Treatment Guideline 2013 recommendations, we explored the cost-effectiveness of different strategy combinations according to the South African HIV-infected mothers' prompt treatments and different feeding patterns.Study DesignA decision analytic model was applied to simulate cohorts of 10,000 HIV-infected pregnant women to compare the cost-effectiveness of two different HIV strategy combinations: (1) Women were tested and treated promptly at any time during pregnancy (Promptly treated cohort). (2) Women did not get testing or treatment until after delivery and appropriate standard treatments were offered as a remedy (Remedy cohort). Replacement feeding or exclusive breastfeeding was assigned in both strategies. Outcome measures included the number of infant HIV cases averted, the cost per infant HIV case averted, and the cost per life year(LY) saved from the interventions. One-way and multivariate sensitivity analyses were performed to estimate the uncertainty ranges of all outcomes.ResultsThe remedy strategy does not particularly cost-effective. Compared with the untreated baseline cohort which leads to 1127 infected infants, 698 (61.93%) and 110 (9.76%) of pediatric HIV cases are averted in the promptly treated cohort and remedy cohort respectively, with incremental cost-effectiveness of $68.51 and $118.33 per LY, respectively. With or without the antenatal testing and treatments, breastfeeding is less cost-effective ($193.26 per LY) than replacement feeding ($134.88 per LY), without considering the impact of willingness to pay.ConclusionCompared with the prompt treatments, remedy in labor or during the postnatal period is less cost-effective. Antenatal HIV testing and prompt treatments and avoiding breastfeeding are the best strategies. Although encouraging mothers to practice replacement feeding in South Africa is far from easy and the advantages of breastfeeding can not be ignored, we still suggest choosing replacement feeding as far as possible.
Highlights
Identification of human immunodeficiency virus (HIV) infection is critical from both clinical and public health perspectives
Compared with the untreated baseline cohort which leads to 1127 infected infants, 698 (61.93%) and 110 (9.76%) of pediatric HIV cases are averted in the promptly treated cohort and remedy cohort respectively, with incremental cost-effectiveness of $68.51 and $118.33 per life years (LY), respectively
Three theoretical cohorts(the promptly treated cohort, the remedy cohort and the no intervention control cohort) were applied in our analytic model, all of which were based on estimates of 40% breast feeding coverage and 15.4% replacement feeding rate during postpartum
Summary
Identification of human immunodeficiency virus (HIV) infection is critical from both clinical and public health perspectives. An interview study of 760 HIV-infected persons in Los Angeles County suggested that many persons reported with Acquired Immune Deficiency Syndrome (AIDS) were unaware of their infection until relatively late in their disease course. A survey had suggested that late HIV diagnosis may lead to accelerted progression and that some of the patients in the survey developed AIDS within a year of HIV infection[6]. These findings are in excellent agreement with those reported by other researchers [7]
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