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  • Title: Cost effectiveness of single-dose nevirapine regimen for mothers and babies to decrease vertical HIV-1 transmission in sub-Saharan Africa.
    Author: Marseille E, Kahn JG, Mmiro F, Guay L, Musoke P, Fowler MG, Jackson JB.
    Journal: Lancet; 1999 Sep 04; 354(9181):803-9. PubMed ID: 10485721.
    Abstract:
    BACKGROUND: Identification of economical interventions to decrease HIV-1 transmission to children is an urgent public-health priority in sub-Saharan Africa. We assessed the cost effectiveness of the HIVNET 012 nevirapine regimen. METHODS: We assessed cost effectiveness in a hypothetical cohort of 20,000 pregnant women in sub-Saharan Africa. Our main outcome measures were programme cost, paediatric HIV-1 cases averted, cost per case averted, and cost per disability-adjusted life-year (DALY). We compared HIVNET 012 with other short-course antiretroviral regimens. We also compared two implementation strategies: counselling and HIV-1 testing before treatment (targeted treatment), or nevirapine for all pregnant women (universal treatment, no counselling and testing). We did univariate and multivariate sensitivity analyses. FINDINGS: For universal treatment with 30% HIV-1 seroprevalence, the HIVNET 012 regimen would avert 603 cases of HIV-1 in babies, cost US$83,333, and generate 15,862 DALYs. The associated cost-effectiveness ratios were $138 per case averted or $5.25 per DALY. At 15% seroprevalence, the universal treatment option would cost $83,333 and avert 302 cases at $276 per case averted or $10.51 per DALY. For targeted treatment at 30% seroprevalence, HIVNET 012 would cost $141,922 and avert 476 cases at $298 per case averted or $11.29 per DALY. With seroprevalence higher than 3.0% for universal and 4.5% for targeted treatment, the HIVNET 012 regimen was likely to be as cost effective as other public-health interventions. The cost effectiveness of HIVNET 012 was robust under a wide range of parameters in the sensitivity analysis. INTERPRETATION: The HIVNET 012 regimen can be highly cost-effective in high seroprevalence settings. In lower seroprevalence areas, when multidose regimens are not cost effective, nevirapine therapy could have a major public-health impact at a reasonable cost. The cost effectiveness of HIVNET 012 nevirapine regimen for treatment of HIV-1-positive mothers was assessed in a hypothetical cohort of 20,000 pregnant women in sub-Saharan Africa. The program cost, pediatric HIV-1 cases averted, and cost per disability-adjusted life-year (DALY) were the main outcome measures. Univariate and multivariate analyses were used. Results showed that the nevirapine program would avert from 603 pediatric HIV-1 cases (universal treatment at 30% seroprevalence) to 246 cases (targeted treatment at 15% seroprevalence). At 30% seroprevalence, the universal treatment would cost $83,333 with 15,862 DALY. At 15% seroprevalence, it would cost $83,333 and avert 302 cases at $276 per case averted. The HIVNET 012 regimen was more effective and less costly than other regimens. The HIVNET 012 regimen would retain cost effectiveness at seroprevalence as low as 10.7% under the universal treatment option and 22% under the targeted treatment option. Furthermore, the HIVNET 012 regimen can be highly cost-effective in high seroprevalence settings. On the other hand, in areas with low seroprevalence, nevirapine therapy could have an important public health impact at a reasonable cost.
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