. 2012 Nov 30;56(3):430–446. doi: 10.1093/cid/cis858

Table 3.

Cost-effectiveness of World Health Organization 2010 Prevention of Mother-to-Child HIV Transmission Guidelines in Zimbabwe

Modeled Scenario and PMTCT Regimen	Combined Costs per Mother–Infant Pair, Discounted, 2008 US Dollars^a	Combined Life Expectancy per Mother–Infant Pair, Discounted, Years From Delivery^b	ICER, US Dollars per YLS
Base-Case Projections^c
Base-case projections (100% PMTCT uptake, retention in postnatal maternal care, pediatric ART availability)
Option B	5630	38.32
Option A	5710	37.89	Dominated^d
sdNVP	5760	36.97	Dominated
No antenatal ARVs	5880	36.03	Dominated
Option B+	6620	39.04	1370
Sensitivity Analyses^e
Access to care parameters:
Reduced PMTCT uptake (56% of HIV-infected women receiving ARVs by delivery; 87% linkage to postnatal care)
Option B	4930	35.69
Option A	4980	35.44	Dominated
sdNVP	5000	34.92	Dominated
No antenatal ARVs	5060	34.39	Dominated
Option B+	5600	36.18	1370
Increased maternal loss to follow-up after delivery (16% in year 1, 6% per year thereafter)
Option B	3420	35.23
Option A	3560	34.90	Dominated
sdNVP	3620	34.06	Dominated
No antenatal ARVs	3730	33.05	Dominated
Option B+	3910	35.81	850
Reduced pediatric ART availability (36% of infected children; 2009 Zimbabwe estimate)
Option B	5610	38.00
sdNVP	5670	35.96	Dominated
Option A	5670	37.41	Dominated
No antenatal ARVs	5690	34.06	Dominated
Option B+	6590	38.71	1370
Current access to care (56% PMTCT uptake, 87% linkage to postnatal maternal care, increased maternal LTFU, 36% pediatric ART availability)
Option B	3010	31.99
sdNVP	3090	30.94	Dominated
Option A	3090	31.72	Dominated
No antenatal ARVs	3100	29.83	Dominated
Option B+	3340	32.38	850
Clinical health parameters:
“Treatment fatigue”: monthly risk of virologic failure after 6 mo on first-line NNRTI-based ART = 2.39% for women starting ART with CD4 count >350 cells/µL (Options B/B+) (1.5 × base-case risk)
Option B	5700	37.82
Option A	5710	37.89	190
sdNVP	5760	36.97	Dominated
No antenatal ARVs	5880	36.03	Dominated
Option B+	6700	38.67	1260
Resource utilization parameters:
South Africa healthcare costs
Option B	14 040	38.33
Option A	14 260	37.89	Dominated
sdNVP	14 730	36.97	Dominated
Option B+	15 070	39.05	1410
No antenatal ARVs	15 520	36.04	Dominated
Additional $150 antenatal implementation cost for 3-drug regimens compared with ZDV alone
Option A	5760	37.89
Option B	5760	38.32	2
sdNVP	5770	36.97	Dominated
No ARVs	5880	36.03	Dominated
Option B+	6750	39.04	1370

Abbreviations: ART, antiretroviral therapy; ARV, antiretroviral medications; HIV, human immunodeficiency virus; ICER, incremental cost-effectiveness ratio; LTFU, lost to follow-up; NNRTI, nonnucleoside reverse transcriptase inhibitor; PMTCT, prevention of mother-to-child transmission; sdNVP, single-dose nevirapine; YLS, year of life saved; ZDV, zidovudine.

^a Combined costs = PMTCT program costs + maternal lifetime HIV-related healthcare costs + infant lifetime healthcare cost (per mother–infant pair).

^b Combined life expectancy = maternal life expectancy from delivery + infant life expectancy from birth.

^c Base-case results. Base-case projections assume 100% uptake of PMTCT services by the time of delivery, 100% linkage to HIV care during breastfeeding, no maternal loss to follow-up after delivery, and 100% availability of pediatric ART for HIV-infected infants.

^d Dominated refers to an intervention that is more expensive and less effective than an alternative intervention.

^e Sensitivity analyses. Please see Supplementary Table 5 for additional details regarding all sensitivity analyses, including the distribution of costs and life expectancy between mothers and infants.