Table 3.
Economic evaluations of interventions to reduce mother to child transmission (MTCT) of HIV: estimates of effectiveness1
Study | Infant HIV cases averted | Reduction in forward transmission2 | Life years | QALYs3 or DALYs4 |
---|---|---|---|---|
[32] | (0) 3764 (1) 4250 per 100,000 births5 |
n/a6 | n/a | n/a |
[33] | (1) 0.70 (2) 0.62 (3) 0.31 per 100 women |
A 30% benefit was incorporated in the base case and varied from 10-50% in sensitivity analyses | n/a | (1) 13.2 (2) 11.6 (3) 5.8 DALYs per 100 women |
[29] | (1) 99 (2) 272 (3) 307 |
n/a | n/a | n/a |
[34] | (1) 476 (2) 603 (3) 315 (4) 229 (5) 309 per 20 000 women |
A 30% benefit was considered in sensitivity analyses. | n/a | (1) 12572 (2) 15862 (3) 8326 (4) 6041 (5) 8163 DALYs per 20 000 women |
[30] | (Total deaths averted) (1) 26 (2) 25 (3) 5 (4) 37 (5) 200 (6) 124 (7) 160 (8) 188 (9) 200 |
n/a | (1) 461 (2) 449 (3) 98 (4) 661 (5) 3 655 (6) 2 260 (7) 2 926 (8) 3 434 (9) 3 654 |
n/a |
[35] | (1) 137 (2) 160 (3) 89 (4) 142 |
n/a | n/a | n/a |
[36] | 23 181 | n/a | n/a | |
[37] | n/a | n/a | n/a | n/a |
[23] | (0) 4 & 3 (1) 91 & 64 (2) 46 & 32 (3) 91 & 64 (4) 102 & 72 All reported for ACTG 076 & HIVNET 012 |
30% external benefit considered in sensitivity analyses | n/a | n/a |
[25] | (1) Botswana: 243 Ivory Coast: 435 Kenya: 904 Rwanda: 1 380 Tanzania: 2 774 Uganda: 1 375 Zambia: 629 Zimbabwe: 1 013 |
n/a | n/a | (1) 7 BWA: 7571 CIV: 12 984 KEN: 27 784 RWA: 39 095 TZA: 82 806 UGA: 39 846 ZMB: 18 873 ZWE: 31 462 DALYs |
[31] | Not given | n/a | (0) 446 208 (1) 445 922 (2) 447 391 (3) 451 250 (4) 446 869 (5) 446 187 QALYs |
|
[27] | (0) 233 (1) 258 (2) 273 (3) 337 (4) 245 (5) 271 (6) 300 (7) 353 |
n/a | n/a | n/a |
[22] | (1) 9880 (2) 4403 |
n/a | (1) 131 700 (2) 58 700 Potential years of life lost |
n/a |
[24] | (1) 33.1 (2) 32.5 |
n/a | n/a | n/a |
[28] | (1) 3436 (2) 3436 (3) 3406 (4) 3406 (5) 5031 (6) 5031 For 2 VCT strategy |
n/a | n/a | (1) 776.48 (2) 1158.74 (3) 1299.76 (4) 1939.63 (5) 1147.84 (6) 1712.92 QALYs for 2 VCT strategy |
[26] | (1) 91 (2) 88 |
VCT may prevent HIV acquisition in discordant couples where the male is HIV+ve | n/a | n/a |
[38] | (0) 241 596 (1) 71 945 (additional) |
n/a | n/a | n/a |
[40] | (1) 0.51 (2) 2.67 per 1000 |
n/a | n/a | (1) 12.9 (2) 67 per 1000 |
[39] | (1) 370 | 15% benefit incorporated in base case (0%-30% in sensitivity analyses) | n/a | (1) 10 449 |
1Numbers in round brackets correspond to the intervention strategies presented in Table 1.
2This is reduction in adult-to-adult transmission due to VCT (voluntary counseling and testing). All studies consider provider-initiated HIV testing (PIHT)).
3QALY = Quality-adjusted life years
4DALY = Disability-adjusted life years
5SOC = Societal (considers direct and indirect costs); PPHC = Public payer of healthcare costs (considers direct costs only); PRO = Provider (considers direct medical costs covered by the facility)
6n/a = not applicable
7 These are three-letter country codes published by the International Organization for Standardization (ISO)