Cost effectiveness of option B plus for prevention of mother-to-child transmission of HIV in resource-limited countries: evidence from Kumasi, Ghana
Identifieur interne : 000377 ( Main/Exploration ); précédent : 000376; suivant : 000378Cost effectiveness of option B plus for prevention of mother-to-child transmission of HIV in resource-limited countries: evidence from Kumasi, Ghana
Auteurs : Adam Vandeusen [États-Unis] ; Elijah Paintsil [États-Unis] ; Thomas Agyarko-Poku [Ghana] ; Elisa F. Long [États-Unis]Source :
- BMC Infectious Diseases [ 1471-2334 ] ; 2015.
Descripteurs français
- KwdFr :
- Allaitement maternel (), Analyse coût-bénéfice, Années de vie ajustées sur la qualité, Antirétroviraux (usage thérapeutique), Antirétroviraux (économie), Chimioprévention (), Chimioprévention (économie), Complications de la grossesse et maladies infectieuses (traitement médicamenteux), Complications de la grossesse et maladies infectieuses (économie), Complications de la grossesse et maladies infectieuses (épidémiologie), Enfant, Enfant d'âge préscolaire, Femelle, Ghana (épidémiologie), Grossesse, Humains, Infections à VIH (), Infections à VIH (transmission), Infections à VIH (économie), Infections à VIH (épidémiologie), Modèles économétriques, Nouveau-né, Relations mère-enfant, Ressources en santé (économie), Transmission verticale de maladie infectieuse (), Transmission verticale de maladie infectieuse (économie), VIH-1 (Virus de l'Immunodéficience Humaine de type 1), Études rétrospectives.
- MESH :
- traitement médicamenteux : Complications de la grossesse et maladies infectieuses.
- usage thérapeutique : Antirétroviraux, Infections à VIH.
- économie : Antirétroviraux, Chimioprévention, Complications de la grossesse et maladies infectieuses, Infections à VIH, Ressources en santé, Transmission verticale de maladie infectieuse.
- épidémiologie : Complications de la grossesse et maladies infectieuses, Ghana, Infections à VIH.
- Allaitement maternel, Analyse coût-bénéfice, Années de vie ajustées sur la qualité, Chimioprévention, Enfant, Enfant d'âge préscolaire, Femelle, Grossesse, Humains, Infections à VIH, Modèles économétriques, Nouveau-né, Relations mère-enfant, Transmission verticale de maladie infectieuse, VIH-1 (Virus de l'Immunodéficience Humaine de type 1), Études rétrospectives.
- Wicri :
- geographic : Ghana.
English descriptors
- KwdEn :
- Anti-Retroviral Agents (economics), Anti-Retroviral Agents (therapeutic use), Breast Feeding (statistics & numerical data), Chemoprevention (economics), Chemoprevention (statistics & numerical data), Child, Child, Preschool, Cost-Benefit Analysis, Female, Ghana (epidemiology), HIV Infections (economics), HIV Infections (epidemiology), HIV Infections (prevention & control), HIV Infections (transmission), HIV-1, Health Resources (economics), Humans, Infant, Newborn, Infectious Disease Transmission, Vertical (economics), Infectious Disease Transmission, Vertical (prevention & control), Infectious Disease Transmission, Vertical (statistics & numerical data), Models, Econometric, Mother-Child Relations, Pregnancy, Pregnancy Complications, Infectious (drug therapy), Pregnancy Complications, Infectious (economics), Pregnancy Complications, Infectious (epidemiology), Quality-Adjusted Life Years, Retrospective Studies.
- MESH :
- chemical , economics : Anti-Retroviral Agents.
- chemical , therapeutic use : Anti-Retroviral Agents.
- geographic , epidemiology : Ghana.
- drug therapy : Pregnancy Complications, Infectious.
- economics : Chemoprevention, HIV Infections, Health Resources, Infectious Disease Transmission, Vertical, Pregnancy Complications, Infectious.
- epidemiology : HIV Infections, Pregnancy Complications, Infectious.
- prevention & control : HIV Infections, Infectious Disease Transmission, Vertical.
- statistics & numerical data : Breast Feeding, Chemoprevention, Infectious Disease Transmission, Vertical.
- transmission : HIV Infections.
- Child, Child, Preschool, Cost-Benefit Analysis, Female, HIV-1, Humans, Infant, Newborn, Models, Econometric, Mother-Child Relations, Pregnancy, Quality-Adjusted Life Years, Retrospective Studies.
Abstract
Achieving the goal of eliminating mother-to-child HIV transmission (MTCT) necessitates increased access to antiretroviral therapy (ART) for HIV-infected pregnant women. Option B provides ART through pregnancy and breastfeeding, whereas Option B+ recommends continuous ART regardless of CD4 count, thus potentially reducing MTCT during future pregnancies. Our objective was to compare maternal and pediatric health outcomes and cost-effectiveness of Option B+ versus Option B in Ghana.
A decision-analytic model was developed to simulate HIV progression in mothers and transmission (in utero, during birth, or through breastfeeding) to current and all future children. Clinical parameters, including antenatal care access and fertility rates, were estimated from a retrospective review of 817 medical records at two hospitals in Ghana. Additional parameters were obtained from published literature. Modeled outcomes include HIV infections averted among newborn children, quality-adjusted life-years (QALYs), and cost-effectiveness ratios.
HIV-infected women in Ghana have a lifetime average of 2.3 children (SD 1.3). Projected maternal life expectancy under Option B+ is 16.1 years, versus 16.0 years with Option B, yielding a gain of 0.1 maternal QALYs and 3.2 additional QALYs per child. Despite higher initial ART costs, Option B+ costs $785/QALY gained, a value considered very cost-effective by World Health Organization benchmarks. Widespread implementation of Option B+ in Ghana could theoretically prevent up to 668 HIV infections among children annually. Cost-effectiveness estimates remained favorable over robust sensitivity analyses.
Although more expensive than Option B, Option B+ substantially reduces MTCT in future pregnancies, increases both maternal and pediatric QALYs, and is a cost-effective use of limited resources in Ghana.
The online version of this article (doi:10.1186/s12879-015-0859-2) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1186/s12879-015-0859-2
PubMed: 25887574
PubMed Central: 4374181
Affiliations:
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Le document en format XML
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Long</name><affiliation wicri:level="2"><nlm:aff id="Aff4">University of California Los Angeles, Anderson School of Management, Los Angeles, CA USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Californie</region></placeName><wicri:cityArea>University of California Los Angeles, Anderson School of Management, Los Angeles</wicri:cityArea></affiliation></author></analytic><series><title level="j">BMC Infectious Diseases</title><idno type="eISSN">1471-2334</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Anti-Retroviral Agents (economics)</term><term>Anti-Retroviral Agents (therapeutic use)</term><term>Breast Feeding (statistics & numerical data)</term><term>Chemoprevention (economics)</term><term>Chemoprevention (statistics & numerical data)</term><term>Child</term><term>Child, Preschool</term><term>Cost-Benefit Analysis</term><term>Female</term><term>Ghana (epidemiology)</term><term>HIV Infections (economics)</term><term>HIV Infections (epidemiology)</term><term>HIV Infections (prevention & control)</term><term>HIV Infections (transmission)</term><term>HIV-1</term><term>Health Resources (economics)</term><term>Humans</term><term>Infant, Newborn</term><term>Infectious Disease Transmission, Vertical (economics)</term><term>Infectious Disease Transmission, Vertical (prevention & control)</term><term>Infectious Disease Transmission, Vertical (statistics & numerical data)</term><term>Models, Econometric</term><term>Mother-Child Relations</term><term>Pregnancy</term><term>Pregnancy Complications, Infectious (drug therapy)</term><term>Pregnancy Complications, Infectious (economics)</term><term>Pregnancy Complications, Infectious (epidemiology)</term><term>Quality-Adjusted Life Years</term><term>Retrospective Studies</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Allaitement maternel 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infectieuse ()</term><term>Transmission verticale de maladie infectieuse (économie)</term><term>VIH-1 (Virus de l'Immunodéficience Humaine de type 1)</term><term>Études rétrospectives</term></keywords><keywords scheme="MESH" type="chemical" qualifier="economics" xml:lang="en"><term>Anti-Retroviral Agents</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anti-Retroviral Agents</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Ghana</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Pregnancy Complications, Infectious</term></keywords><keywords scheme="MESH" qualifier="economics" xml:lang="en"><term>Chemoprevention</term><term>HIV Infections</term><term>Health Resources</term><term>Infectious Disease Transmission, Vertical</term><term>Pregnancy Complications, Infectious</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>HIV Infections</term><term>Pregnancy Complications, Infectious</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>HIV Infections</term><term>Infectious Disease Transmission, Vertical</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Breast Feeding</term><term>Chemoprevention</term><term>Infectious Disease Transmission, Vertical</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Complications de la grossesse et maladies infectieuses</term></keywords><keywords scheme="MESH" qualifier="transmission" xml:lang="en"><term>HIV Infections</term></keywords><keywords scheme="MESH" qualifier="usage thérapeutique" xml:lang="fr"><term>Antirétroviraux</term><term>Infections à VIH</term></keywords><keywords scheme="MESH" qualifier="économie" xml:lang="fr"><term>Antirétroviraux</term><term>Chimioprévention</term><term>Complications de la grossesse et maladies infectieuses</term><term>Infections à VIH</term><term>Ressources en santé</term><term>Transmission verticale de maladie infectieuse</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Complications de la grossesse et maladies infectieuses</term><term>Ghana</term><term>Infections à VIH</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Child</term><term>Child, Preschool</term><term>Cost-Benefit Analysis</term><term>Female</term><term>HIV-1</term><term>Humans</term><term>Infant, Newborn</term><term>Models, Econometric</term><term>Mother-Child Relations</term><term>Pregnancy</term><term>Quality-Adjusted Life Years</term><term>Retrospective Studies</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Allaitement maternel</term><term>Analyse coût-bénéfice</term><term>Années de vie ajustées sur la qualité</term><term>Chimioprévention</term><term>Enfant</term><term>Enfant d'âge préscolaire</term><term>Femelle</term><term>Grossesse</term><term>Humains</term><term>Infections à VIH</term><term>Modèles économétriques</term><term>Nouveau-né</term><term>Relations mère-enfant</term><term>Transmission verticale de maladie infectieuse</term><term>VIH-1 (Virus de l'Immunodéficience Humaine de type 1)</term><term>Études rétrospectives</term></keywords><keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Ghana</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Achieving the goal of eliminating mother-to-child HIV transmission (MTCT) necessitates increased access to antiretroviral therapy (ART) for HIV-infected pregnant women. Option B provides ART through pregnancy and breastfeeding, whereas Option B+ recommends continuous ART regardless of CD4 count, thus potentially reducing MTCT during future pregnancies. Our objective was to compare maternal and pediatric health outcomes and cost-effectiveness of Option B+ versus Option B in Ghana.</p></sec><sec><title>Methods</title><p>A decision-analytic model was developed to simulate HIV progression in mothers and transmission (in utero, during birth, or through breastfeeding) to current and all future children. Clinical parameters, including antenatal care access and fertility rates, were estimated from a retrospective review of 817 medical records at two hospitals in Ghana. Additional parameters were obtained from published literature. Modeled outcomes include HIV infections averted among newborn children, quality-adjusted life-years (QALYs), and cost-effectiveness ratios.</p></sec><sec><title>Results</title><p>HIV-infected women in Ghana have a lifetime average of 2.3 children (SD 1.3). Projected maternal life expectancy under Option B+ is 16.1 years, versus 16.0 years with Option B, yielding a gain of 0.1 maternal QALYs and 3.2 additional QALYs per child. Despite higher initial ART costs, Option B+ costs $785/QALY gained, a value considered very cost-effective by World Health Organization benchmarks. Widespread implementation of Option B+ in Ghana could theoretically prevent up to 668 HIV infections among children annually. Cost-effectiveness estimates remained favorable over robust sensitivity analyses.</p></sec><sec><title>Conclusions</title><p>Although more expensive than Option B, Option B+ substantially reduces MTCT in future pregnancies, increases both maternal and pediatric QALYs, and is a cost-effective use of limited resources in Ghana.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1186/s12879-015-0859-2) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Baiden, F" uniqKey="Baiden F">F Baiden</name></author><author><name sortKey="Baiden, R" uniqKey="Baiden R">R Baiden</name></author><author><name sortKey="Williams, J" uniqKey="Williams J">J Williams</name></author><author><name sortKey="Akweongo, P" uniqKey="Akweongo P">P Akweongo</name></author><author><name sortKey="Clerk, C" uniqKey="Clerk C">C Clerk</name></author><author><name sortKey="Debpuur, C" uniqKey="Debpuur C">C Debpuur</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Shah, M" uniqKey="Shah M">M Shah</name></author><author><name sortKey="Johns, B" uniqKey="Johns B">B Johns</name></author><author><name sortKey="Abimiku, A" uniqKey="Abimiku A">A Abimiku</name></author><author><name sortKey="Walker, Dg" uniqKey="Walker D">DG Walker</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ciaranello, Al" uniqKey="Ciaranello A">AL Ciaranello</name></author><author><name sortKey="Perez, F" uniqKey="Perez F">F Perez</name></author><author><name sortKey="Engelsmann, B" uniqKey="Engelsmann B">B Engelsmann</name></author><author><name sortKey="Walensky, Rp" uniqKey="Walensky R">RP 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Gold</name></author><author><name sortKey="Kamlet, Ms" uniqKey="Kamlet M">MS Kamlet</name></author><author><name sortKey="Russell, Lb" uniqKey="Russell L">LB Russell</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Van Hulst, M" uniqKey="Van Hulst M">M van Hulst</name></author><author><name sortKey="Sagoe, Kw" uniqKey="Sagoe K">KW Sagoe</name></author><author><name sortKey="Vermande, Je" uniqKey="Vermande J">JE Vermande</name></author><author><name sortKey="Van Der Schaaf, Ip" uniqKey="Van Der Schaaf I">IP van der Schaaf</name></author><author><name sortKey="Van Der Tuuk Adriani, Wp" uniqKey="Van Der Tuuk Adriani W">WP van der Tuuk Adriani</name></author><author><name sortKey="Torpey, K" uniqKey="Torpey K">K Torpey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kahn, Jg" uniqKey="Kahn J">JG Kahn</name></author><author><name sortKey="Marseille, E" uniqKey="Marseille E">E Marseille</name></author><author><name sortKey="Auvert, B" uniqKey="Auvert B">B Auvert</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Long, E" uniqKey="Long E">E Long</name></author><author><name sortKey="Stavert, Rr" uniqKey="Stavert R">RR Stavert</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hogan, Dr" uniqKey="Hogan D">DR Hogan</name></author><author><name sortKey="Baltussen, R" uniqKey="Baltussen R">R Baltussen</name></author><author><name sortKey="Hayashi, C" uniqKey="Hayashi C">C Hayashi</name></author><author><name sortKey="Lauer, Ja" uniqKey="Lauer J">JA Lauer</name></author><author><name sortKey="Salomon, Ja" uniqKey="Salomon J">JA Salomon</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Achana, Fs" uniqKey="Achana F">FS Achana</name></author><author><name sortKey="Debpuur, C" uniqKey="Debpuur C">C Debpuur</name></author><author><name sortKey="Akweongo, P" uniqKey="Akweongo P">P Akweongo</name></author><author><name sortKey="Cleland, J" uniqKey="Cleland J">J Cleland</name></author></analytic></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Ghana</li><li>États-Unis</li></country><region><li>Californie</li><li>Connecticut</li></region></list><tree><country name="États-Unis"><region name="Connecticut"><name sortKey="Vandeusen, Adam" sort="Vandeusen, Adam" uniqKey="Vandeusen A" first="Adam" last="Vandeusen">Adam Vandeusen</name></region><name sortKey="Long, Elisa F" sort="Long, Elisa F" uniqKey="Long E" first="Elisa F" last="Long">Elisa F. Long</name><name sortKey="Paintsil, Elijah" sort="Paintsil, Elijah" uniqKey="Paintsil E" first="Elijah" last="Paintsil">Elijah Paintsil</name></country><country name="Ghana"><noRegion><name sortKey="Agyarko Poku, Thomas" sort="Agyarko Poku, Thomas" uniqKey="Agyarko Poku T" first="Thomas" last="Agyarko-Poku">Thomas Agyarko-Poku</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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