Table 4.
Cost-effectiveness of interventions to reduce mother to child transmission (MTCT) of HIV (2008 I$)1, 2, 3
| Study | Cost per infant HIV infection averted | Cost per life year | Cost per QALY4 or DALY5 | Intervention C/E? (benchmark)6 |
|---|---|---|---|---|
| [32] | (1) 3 748 (PPHC) (1) 1 454 (SOC) |
n/a | n/a | No7 |
| [33] | (1) 6 515 (2) 3 401 (3) 1 433 |
n/a | (1) 348 (2) 181 (3) 76 Cost per DALY |
Yes |
| [29] | (1) 7 368 (2) 7 095 (3) 3 162 |
(1) 260; 452 (2) 251; 435 (3) 112; 194 All reported as 3%; 6% discount rate. |
n/a | Yes |
| [34] | (1) 373 (2) 173 (3) 3 479 (4) 1 582 (5) 1 387 |
n/a | (1) 14 (2) 7 (3) 132 (4) 60 (5) 52 Cost per DALY |
Yes (WDR8) |
| [30] | (1) 4 503 (2) 5 879 (3) 25 083 (4) 7 464 (5) 3 053 (6) 315 (7) CS9 (8) CS (9) 837 |
(1) 250 (2) 323 (3) 1 390 (4) 414 (5) 167 (6) 18 (7) CS (8) CS (9) 46 |
n/a | Yes (WDR) |
| [35] | (1) 1 044 (2) 1 021 (3) 1 196 (4) 1 021 |
From $5-$141 | n/a | Yes |
| [36] | 1 787 | n/a | 17 per DALY | Yes |
| [37] | n/a | (1) 23 (2) 23 (3) 163 (4) 18 363 |
n/a | Yes |
| [23] | (0) 99 430 (1) 99 318 (2) 61 286 (3) 64 732 (4) 65 733 |
n/a | n/a | No10 |
| [25] | BWA: 2 022 CIV: 10 354 KEN: 4 800 RWA: 2 089 TZA: 2 554 UGA: 5 432 ZMB: 2 870 ZWE: 3 996 |
n/a | BWA: 65 CIV: 347 KEN: 157 RWA: 74 TZA: 86 UGA: 188 ZMB: 96 ZWE: 129 per DALY |
Yes |
| [31] | n/a | n/a | (0) 1.96 (1) 1.98 (2) 3.25 (3) 2.98 (4) 2.46 (5) 3.60 per QALY |
Yes (WDR) |
| [27] | (0) 716 (1) 851 (2) 570 (3) 556 (4) 1 740 (5) 1 776 (6) 1 381 (7) 1 266 |
n/a | n/a | Yes (Thai12) |
| [22] | (1) 1 824.61 (2) 709.30 |
(1) 136.91 (2) 64.18 |
n/a | Yes (WDR), but relative cost-effectiveness is questionable10 |
| [24] | (1) 857 (2) 663 |
n/a | n/a | No13 |
| [28] | n/a | n/a | (1) CS (2) 65 (3) CS (4) 0.5 (5) CS (6) 12.94 Incremental costs per QALY |
Yes (WDR) |
| [26] | n/a | n/a | (0) 15.34 (1) 15.39 per DALY |
Yes |
| [38] | (0) $543 (1) $359 (additional cost for family planning) |
n/a | n/a | Yes |
| [40] | (1) 27 409 (2) 7 361 |
n/a | (1) Dominated (2) 293 per DALY |
Yes/1* GDP per capita per DALY14 |
| [39] | (1) $1010 (PRO) (1) -$267 (PPHC) |
n/a | (1) $36 (PRO) (1) -$17 (PPHC) per DALY |
Yes/$50 per DALY8 and 1* GDP per capita per DALY14 |
1 To enhance comparability, all costs in this table are presented in 2008 International dollars (I$) using GDP deflators and purchasing power parities available from the International Monetary Fund [54].
2 Numbers in round brackets correspond to the intervention strategies presented in Table 1. Although several studies comparing multiple strategies also provide incremental results [27-29,40], results comparing individual strategies to a do-nothing alternative are presented where possible. The exception is [28].
3 SOC = 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)
4 QALY = Quality-adjusted life years
6 DALY = Disability-adjusted life years
6 These are the study authors' conclusions about the value of one or more interventions to prevent MTCT of HIV. If a benchmark was used to justify the conclusion, it is provided in brackets.
7 Study based on older (higher) drug prices and lower regimen effectiveness.
8 The 1993 World Development Report: Investing in Health proposed that interventions costing less than $100 per life year saved are cost effective for middle-income countries while $50 per life-year gained is a reasonable benchmark for low-income countries [33]. This was updated to $64 per QALY in low-income settings ($50 per QALY gained, adjusted to 2003 dollars) by [26] and [29].
9 CS = Cost saving
10 Concentrated epidemic; very low HIV prevalence.
11 Three-letter country codes published by the International Organization for Standardization (ISO). See Table 3.
12 Authors used the Thai health system's thresholds for adopting health technologies as a benchmark.
13Authors' conclusions comparing the effectiveness of an ARV-based regimen (pMTCT component 3) to a family planning strategy (pMTCT component 1). Both strategies would likely be cost-effective using standard benchmarks.
14 The WHO Commission on Macroeconomics in Health proposed that interventions costing 1*GDP per capita per DALY should be considered "very cost-effective", while those costing <3*GDP per capita should be considered "cost-effective" [44].