Table 2.
Intervention cost and output results.
| Reference | Scenario | Outcome measure | Cost-effectiveness measure reported in publication (US$) | Cost-effectiveness measure (US$ 2018) | Discount rate | Country GDP per capita (current US$), 2018a[76] |
|---|---|---|---|---|---|---|
| VMMC | ||||||
| Binagwaho et al. (2010) [15] | Infants | 1288 HIAl | Cost-saving | -- | 3% | Rwanda: $800 ⋅ 21 |
| Adolescents | 1283 HIA | CERl = $3,932/HIA | $4,698/HIA | |||
| Adults | 859 HIA | CER = $4,949/HIA | $5,914/HIA | |||
| Njeuhmeli et al. (2011) [16] | 80% VMMC coverage in 13 countries | 9 VMMCs/1 HIA | $809/HIA | $927/HIA | NR | SSA: $1,620 ⋅ 00 |
| Uthman et al. (2011) [17] | All adult males | 15 ⋅ 5 DALYl averted/HIA | $-325/DALY averted (cost savings) | $-388/DALY averted | 3% | SSA: $1,620 ⋅ 00 |
| Duffy et al. (2013) [18] | Surgical circumcision method | NRm | $430/HIA | $470/HIA | NR | Uganda: $717 ⋅ 50 |
| PrePex circumcision method | NR | $580/HIA | $634/HIA | |||
| Menon et al. (2014) [19] | Scale-up and maintenance of 80% VMMC coverage | NR | $3,200/HIA | $3,668/HIA | 3% | Tanzania: $1,090 ⋅ 00 |
| Awad et al. (2015) [20] | Current VMMC scale-up program | 326,000 HIA 11 VMMCs/1 HIA (2010-2025) |
$1,010/HIA | $1,072/HIA | 3% | Zimbabwe: $1,270 ⋅ 00 |
| VMMC program with subpopulation prioritization | 10-53 VMMCs/1 HIA | $811-$5,518/HIA | $861-$5,861/HIA | |||
| Awad et al. (2015) [21] | Current VMMC scale-up program | 306,000 HIA 23 VMMCs/1 HIA (2010-2017) 12 VMMCs/1 HIA (2017-2025) |
$1,089/HIA | $1,156/HIA | 3% | Zambia: $1,145 ⋅ 00 |
| VMMC program with subpopulation prioritization | 11-36 VMMCs/1 HIA | $888-$3300/HIA | $943-$3505/HIA | |||
| Haacker et al. (2016) [22] | VMMC at 0 yo | 4 ⋅ 2 VMMCs/HIA | $859/HIA | $919/HIA | 5% | South Africa: $6,560 ⋅ 00 |
| VMMC at 20 yo | 4 ⋅ 4 VMMCs/HIA | $659/HIA | $705/HIA | |||
| VMMC at 55 yo | 214 ⋅ 2 VMMCs/HIA | $24,157/HIA | $25,846/HIA | |||
| Kripke et al. (2016) [23] | 60% coverage among 10-29 yo | 79 HIA | $5,100/HIA | $5,307/HIA | 3% | Malawi: $349 ⋅ 13 |
| 60% coverage among 10–34 yo | 92 HIA | $4,600/HIA | $4,786/HIA | |||
| 60% coverage among 10–49 yo | 106 HIA | $4,600/HIA | $4,786/HIA | |||
| 60% coverage among 15–49 yo | 104 HIA | $3,600/HIA | $3,746/HIA | |||
| 80% coverage among 15–49 yo | 148 HIA | $3,500/HIA | $3,642/HIA | |||
| Kripke et al. (2016) [24] | 80% Scenario: Scale up to 80% among 10-29 yo | 87,000 HIA | $4,800/HIA | $4,994/HIA | 3% | Zimbabwe: $1,270 ⋅ 00 |
| Base Scenario: Scale up to 80% among 10-19 yo | 63,000 HIA | $6,000/HIA | $6,243/HIA | |||
| Scenario A: 80% Scenario with 2x unit cost for 20-29 yo | 78,000 HIA | $6,600/HIA | $6,867/HIA | |||
| Scenario B: 80% Scenario with 2x unit costs for 20-24 yo and 3x unit costs for 25-29 yo | 83,000 HIA | $7,200/HIA | $7,492/HIA | |||
| Kripke et al. (2016) [25] | Actual VMMC performance through 2014 | 240,000 HIA (229,000, 572,000) | $4,400/HIA (median over 14 countries) | $4,578/HIA | 3% (costs only) | SSA: $1,620 ⋅ 00 |
| 80% coverage among 15-49 yo | 1,082,000 HIA (744,000, 1,839,000) | NR | -- | |||
| Kripke et al. (2016) [26] | 50% EIMC coverage/80% coverage among 10-24 yo | 20,000 HIA (14,000, 24,000) | $1,500/HIA ($1,100, $1,900) | $1,560/HIA ($1,144, $1,977) | 3% | Eswatini: $4,090 ⋅ 00 |
| 50% EIMC coverage/80% coverage among 10-29 yo | 27,000 HIA (19,000, 34,000) | $1,300/HIA ($900, $1,600) | $1,352/HIA ($936, $1,664) | |||
| 50% EIMC coverage/80% coverage among 10-34 yo | 29,000 HIA (21,000, 38,000) | $1,200/HIA ($900, $1,600) | $1,248/HIA ($936, $1,664) | |||
| Kripke et al. (2016) [27] | 80% coverage among 10-49 yo | Malawi: 149,000 HIA | $4,600/HIA | $4,600/HIA | Malawi: $349 ⋅ 13 South Africa: $6,560 ⋅ 00 Eswatini: $4,090 ⋅ 00 Tanzania: $1,090 ⋅ 00 Uganda: $717 ⋅ 50 |
|
| South Africa: 375,000 HIA | $2,700/HIA | $2,700/HIA | ||||
| Eswatini: 31,500 HIA | $1,200/HIA | $1,200/HIA | ||||
| Tanzania: 53,400 HIA | $5,800/HIA | $5,800/HIA | ||||
| Uganda: 486,000 HIA | $1,500/HIA | $1,500/HIA | ||||
| 80% coverage among 15-49 yo | Malawi: 148,000 HIA | $3,500/HIA | $3,500/HIA | |||
| South Africa: 372,000 HIA | $2,200/HIA | $2,200/HIA | ||||
| Eswatini: 32,200 HIA | $900/HIA | $900/HIA | ||||
| Tanzania: 50,500 HIA | $4,100/HIA | $4,266/HIA | ||||
| Uganda: 475,000 HIA | $1,100/HIA | $1,144/HIA | ||||
| 80% coverage among 15-24 yo | Malawi: 82,000 HIA | $4,300/HIA | $4,474/HIA | |||
| South Africa: 182,000 HIA | $2,500/HIA | $2,601/HIA | ||||
| Eswatini: 18,900 HIA | $1,000/HIA | $1,040/HIA | ||||
| Tanzania: 28,300 HIA | $4,900/HIA | $5,098/HIA | ||||
| Uganda: 241,000 HIA | $1,400/HIA | $1,456/HIA | ||||
| 80% coverage among 15-29 yo | Malawi: 109,000 HIA | $3,700/HIA | $3,850/HIA | |||
| South Africa: 246,000 HIA | $2,200/HIA | $2,289/HIA | ||||
| Eswatini: 25,700 HIA | $900/HIA | $936/HIA | ||||
| Tanzania: 36,200 HIA | $4,300/HIA | $4,474/HIA | ||||
| Uganda: 324,000 HIA | $1,200/HIA | $1,248/HIA | ||||
| 80% coverage among 15-34 yo | Malawi: 128,000 HIA | $3,500/HIA | $3,642/HIA | |||
| South Africa: 303,000 HIA | $2,100/HIA | $2,185/HIA | ||||
| Eswatini: 29,700 HIA | $900/HIA | $936/HIA | ||||
| Tanzania: 43,200 HIA | $4,000/HIA | $4,162/HIA | ||||
| Uganda: 388,000 HIA | $1,100/HIA | $1,144/HIA | ||||
| 80% coverage among 10-24 yo | Malawi: 83,000 HIA | $6,100/HIA | $6,347/HIA | |||
| South Africa: 190,000 HIA | $3,600/HIA | $3,746/HIA | ||||
| Eswatini: 19,600 HIA | $1,400/HIA | $1,456/HIA | ||||
| Tanzania: 31,300 HIA | $7,800/HIA | $8,116/HIA | ||||
| Uganda: 256,000 HIA | $2,100/HIA | $2,185/HIA | ||||
| 80% coverage among 10-29 yo | Malawi: 110,000 HIA | $5,100/HIA | $5,307/HIA | |||
| South Africa: 250,000 HIA | $3,000/HIA | $3,121/HIA | ||||
| Eswatini: 26,300 HIA | $1,200/HIA | $1,248/HIA | ||||
| Tanzania: 38,700 HIA | $6,800/HIA | $7,076/HIA | ||||
| Uganda: 337,000 HIA | $1,700/HIA | $1,769/HIA | ||||
| Njeuhmeli et al. (2016) [28] | Scale up of VMMC among adolescents | 266,000 HIA | $4,127/HIA | $4,415/HIA | 3% | Zimbabwe: $1,270 ⋅ 00 |
| Introduction of EIMC into existing VMMC program | 268,000 HIA | $5,256/HIA | $5,623/HIA | |||
| PrEP | ||||||
| Pretorius et al. (2010) [29] | Targeted PrEP for 25-35 yo women | NR | $12,500 - $20,000/HIA | $14,328 - $22,924/HIA | NR | South Africa: $6,560 ⋅ 00 |
| Hallett et al. (2011) [30] | PrEP always used after HIV diagnosis in serodiscordant couple | 15% - 52% HIA | $0 - $26,000/HIA | $0 - $28,944/HIA | 3% | South Africa: $6,560 ⋅ 00 |
| PrEP used up through ART initiation for HIV infected partner | 11% - 36% HIA | $-2,200 - $21,000/HIA | $-2,449 - $26,025/HIA | |||
| PrEP used only during periods of trying to conceive a pregnancy and during pregnancy | 1% - 2% HIA | $-6,000 - $8,000/HIA | $-6,679 - $8,906/HIA | |||
| Cremin et al. (2013) [31] | PrEP provided to 7.3% of uninfected 15-24 yo | 3 ⋅ 2% HIA | $10,540/HIA | $11,362/HIA | 3% | South Africa: $6,560 ⋅ 00 |
| PrEP provided to 4.4% of uninfected 15-54 yo | 3 ⋅ 6% HIA | $9,390/HIA | $10,122/HIA | |||
| Nichols et al. (2013) [32] | Non-prioritized PrEP | 2,333 HIA; 23,571 QALYsl gained |
$1,843/QALY gained | $2,051/QALY gained | 3% | Zambia: $1,145 ⋅ 00 |
| Prioritized PrEP | 3,200 HIA; 36,216 QALYs gained |
$323/QALY gained | $359/QALY gained | |||
| Verguet et al. (2013) [33] | PrEP intervention | 200 - 94,100 HIA 3,300 - 1,266,000 DALYs averted |
$550 - $44,600/DALY averted | $612 - $49,651/DALY averted | NR | SSA: $1,620 ⋅ 00 |
| Alistar et al. (2014) [34] | 10% Guidelines ART, 50% Focused PrEP | 1,837,744 HIA | CER = cost saving | CER = cost saving | 3% | South Africa: $6,560 ⋅ 00 |
| 10% Guidelines ART, 100% Focused PrEP | 3,084,508 HIA | CER = cost saving | CER = cost saving | |||
| 50% Guidelines ART, 100% General PrEP | 3,642,543 HIA | $163/QALY gained | $174/QALY gained | |||
| 100% Guidelines ART, 100% Focused PrEP | 3,840,111 HIA | $229/QALY gained | $245/QALY gained | |||
| 50% Universal ART, 100% Focused PrEP | 4,468,827 HIA | $276/QALY gained | $295/QALY gained | |||
| 100% Universal ART, 100% Focused PrEP | 4,663,411 HIA | $302/QALY gained | $323/QALY gained | |||
| 10% Guidelines ART, 50% General PrEP | 2,998,344 HIA | $1,172/QALY gained | $1,253/QALY gained | |||
| 10% Guidelines ART, 100% General PrEP | 3,381,214 HIA | $1,158/QALY gained | $1,239/QALY gained | |||
| Nichols et al. (2014) [35] | Treatment available at CD4 < 500 cells/μL | 3388 HIA; 40,643 QALYs gained |
CER = $62/QALY gained ($46–$75) ICER = $62/QALY gained ($46–$75) |
CER = $69/QALY gained ($51–$83) ICER = $69/QALY gained ($51–$83) |
3% | Zambia: $1,145 ⋅ 00 |
| Prioritized PrEP (most sexually active) | 1502 HIA; 13,611 QALYs gained |
CER = $4,103/QALY gained ($2,890–$5,803) ICERl = dominated |
CER = $4,567/QALY gained ($3,217 – $6,460) ICER = dominated |
|||
| Prioritized PrEP (mostly sexually active and treatment available at CD4 < 500 cells/μL) | 4494 HIA; 50,936 QALYs gained |
CER = $1,153/QALY gained ($686–$1,756) ICER = dominated |
CER = $1,283/QALY gained ($763–$1,954) ICER = dominated |
|||
| Non-prioritized PrEP (randomly distributed) | 4053 HIA; 40,318 QALYs gained |
CER = $3,730/QALY gained ($2,454–$5,691) ICER = dominated |
CER = $4,152/QALY gained ($2,731–$6,335) ICER = dominated |
|||
| Non-prioritized PrEP (randomly distributed and treatment available at CD4 < 500 cells/μL) | 5894 HIA; 67,835 QALYs gained |
CER = $2,253/QALY gained ($1,672–$3,188) ICER = dominated |
CER = $2,508/QALY gained ($1,861–$3,549) ICER = dominated |
|||
| Cremin et al. (2015) [36] | Standard PrEP intervention ($20 million budget) | 24,603 (~ 11%) HIA (3,750 - 49,450) |
$2,060 - $36,360/HIA | $2,293 - $40,478/HIA | 3% | South Africa: $6,560 ⋅ 00 |
| Cremin et al. (2015) [37] | All uninfected women eligible to receive PrEP | NR | $15,647/HIA | $17,419/HIA | 3% | Mozambique: $481 ⋅ 25 |
| Providing PrEP only to partners of miners | NR | $71,374/HIA | $79,458/HIA | |||
| Providing PrEP only to partners of miners and only during the last six weeks of the year | NR | $9,538/HIA | $10,618/HIA | |||
| Ying et al. (2015) [38] | 40% overall ART coverageb; 10% coverage for persons with CD4 350-500 cells/μL | 94,000 HIA | Ref. | -- | 3% | Uganda: $717 ⋅ 50 |
| Increase ART Coverage (50% coverage for persons with CD4 350-500 cells/μL) | 104,000 HIA | Dominated | -- | |||
| Targeted PrEP and ART to 90% serodiscordant couples | 120,000 HIA | $1,340/HIA | $1,466/HIA | |||
| Glaubius et al. (2016) [39] | Optimistic scenario, Non-prioritized PrEP |
1 ⋅ 6% - 9 ⋅ 1% HIA | $20,905 - $22,022/HIA $176,755 - $181,734/LYG |
$22,874 - $24,096/HIA $192,313 - $198,856/LYG |
3% | South Africa: $6,560 ⋅ 00 |
| Optimistic scenario, Age-prioritized PrEP |
2 ⋅ 9% - 17 ⋅ 2% HIA | $10,880 - $11,094/HIA $84,418 - $85,105/LYG |
$11,905 - $12,139/HIA $92,371 - $93,123/LYG |
|||
| Optimistic scenario, Risk-prioritized PrEP |
8 ⋅ 1% HIA | $11,094/HIA $85,105/LYG |
$12,139/HIA $93,123/LYG |
|||
| Conservative scenario, Non-prioritized PrEP |
1 ⋅ 0 - 5 ⋅ 5% HIA | $35,090 - $37,137/HIA $276,605 - $284,781/LYG |
$38,396 - $40,635/HIA $302,665 - $311,611/LYG |
|||
| Conservative scenario, Age-prioritized PrEP |
1 ⋅ 8 - 10 ⋅ 3% HIA | $18,429 - $19,213/HIA $133,428 - $135,695/LYG |
$20,165 - $21,023/HIA $145,999 - $148,479/LYG |
|||
| Conservative scenario, Risk-prioritized PrEP |
4 ⋅ 4% HIA | $1,242/HIA $11,568/LYG |
$1,359/HIA $12,657/LYG |
|||
| Walensky et al. (2016) [40] | Standard PrEP | 127 HIA | $10,100/HIA Cost saving (vs. no PrEP) |
$10,806/HIA | 3% | South Africa: $6,560 ⋅ 00 |
| Long-acting PrEP | 156 HIA | $12,400/HIA Cost saving (vs. no PrEP) |
$13,267/HIA | |||
| Cremin et al. (2017) [41] | 50% PrEP coverage to all FSW | NR | $65,160/HIA (95% CI: $43,520 - $95,250) | $66,404/HIA (95% CI: $44,351 - $97,069) | 0% | Kenya: $1,870 ⋅ 00 |
| 50% PrEP coverage to high-risk FSW | NR | $10,920/HIA (95% CI: $4,700 - $51,560) | $11,128/HIA (95% CI: $4,789 - $52,544) | |||
| TasP | ||||||
| Barnighausen et al. (2012) [42] | Coverage: 70% ART, 20% TasP, 45% MMCl | 650,000 HIA (compared to 50% ART and 45% MMC) | $7,157/HIA | $7,813/HIA | 3% | South Africa: $6,560 ⋅ 00 |
| Coverage: 80% ART, 40% TasP, 45% MMC | 1,000,000 HIA | $7,482/HIA | $8,186/HIA | |||
| Coverage: 80% ART, 60% TasP, 45% MMC | 1,100,000 HIA | $7,937/HIA | $8,684/HIA | |||
| Coverage: 80% ART, 80% TasP, 45% MMC | 1,260,000 HIA | $8,370/HIA | $9,158/HIA | |||
| Granich et al. (2012) [43] | ART initiation at CD4 count ≤ 350 cells/μL vs. ≤ 200 cells/μL | 200,000-1,400,000 HIA | NR | -- | 3% | South Africa: $6,560 ⋅ 00 |
| ART initiation at CD4 count < 500 cells/mm3 vs. ≤ 350 cells/μL | 200,000-1,500,000 HIA | $182/DALY averted | $199/DALY averted | |||
| ART initiation at all CD4 levels vs. CD4 count ≤ 500 cells/μL | 300,000-1,400,000 HIA | $1,381/DALY averted | $1,510/DALY averted | |||
| Smith et al. (2015) [44] | High ART cost | Low ART cost | 3% | South Africa: $6,560 ⋅ 00 | |||
| ART initiation at ≤ 200 cells/μL (vs. status quo) | 2,000 DALYs averted | $22,300/HIA | $12,900/HIA $1,230/DALY averted | $414/DALY averted |
$24,400/HIA | $14,115/HIA $1,345/DALY averted | $453/DALY averted |
|||
| ART initiation at ≤ 350 cells/μL | 3,100 DALYs averted | $10,400/HIA | $4,210/HIA $1,020/DALY averted | $788/DALY averted |
$11,379/HIA | $4,606/HIA $1,116/DALY averted | $851/DALY averted |
|||
| ART initiation at < 500 cells/μL | 3,300 DALYs averted | $8,910/HIA | $2,780/HIA $1,090/DALY averted | $342/DALY averted |
$9,749/HIA | $3,041/HIA $1,192/DALY averted | $374/DALY averted |
|||
| Universal ART | 3,300 DALYs averted | $8,190/HIA | $1,960/HIA $1,300/DALY averted | $310/DALY averted |
$8,961/HIA | $2,144/HIA $1,422/DALY averted | $339/DALY averted |
|||
| Bershteyn et al. (2016) [45] | Targeting 10-30 yo | NR | $6,238/HIA | $6,491/HIA | 3% | South Africa: $6,560 ⋅ 00 |
| Targeting 20-30 yo | NR | $5,031/HIA | $5,235/HIA | |||
| Targeting 22-27 yo | NR | $4,279/HIA | $4,452/HIA | |||
| Targeting 25-27 yo | NR | $3,967/HIA | $4,128/HIA | |||
| Targeting to full population | NR | $10,812/HIA | $11,250/HIA | |||
| Ying et al. (2016) [46] | Base case (36% of HIV-infected people achieving viral suppression) | Ref. | Ref. | -- | 3% | South Africa: $6,560 ⋅ 00 |
| Home HTC (48% of HIV-infected people achieving viral suppression) | 152,000 HIA | $3,290/HIA | $3,546/HIA | |||
| Home HTC + High Viral Load (60% ART uptake if CD4 > 350 cells/μL and VL > 10,000 copies/mL) | 183,000 HIA | $3,320/HIA | $3,579/HIA | |||
| Home HTC + CD4 (60% ART uptake if CD4 350–500 cells/μL) | 195,000 HIA | $2,960/HIA | $3,190/HIA | |||
| PMTCT | ||||||
| Halperin et al. (2009) [47] | Perinatal HIV transmission prevention program | 241,596 HIA | $543/HIA | $631/HIA by perinatal infection | NR | SSA: $1,620 ⋅ 00 |
| Services to prevent unintended pregnancies | 72,000 HIA | $359/HIA | $417/HIA by unintended pregnancy | |||
| Nakakeeto et al. (2009) [48] | Meeting UNGASSl targets for PMTCT by 2010 | NR | Burkina Faso: $2,292/HIA | $2,741/HIA | 3% | Burkina Faso: $734.03 Cameroon: $1,540 ⋅ 00 Cote d’Ivoire: $1,790 ⋅ 00 Malawi: $349 ⋅ 13 Rwanda: $800 ⋅ 21 Tanzania: $1,090 ⋅ 00 Zambia: $1,145 ⋅ 00 |
| Cameroon: $1,366/HIA | $1,633/HIA | |||||
| Cote d’Ivoire: $1,391/HIA | $1,663/HIA | |||||
| Malawi: $965/HIA | $1,154/HIA | |||||
| Rwanda: $1,085/HIA | $1,297/HIA | |||||
| Tanzania: $1,068/HIA | $1,277/HIA | |||||
| Zambia: $829/HIA | $991/HIA | |||||
| Orlando et al. (2010) [49] | PMTCT program with VCT, HAART, treatment of malnutrition, TB, malaria, STDs (private perspective) | 370 HIA 10,449 DALYs averted |
$998/HIA $35 ⋅ 36/DALY averted |
$1,193/HIA $42 ⋅ 30/DALY averted |
3% | Malawi: $349 ⋅ 13 |
| PMTCT program with VCT, HAART, treatment of malnutrition, TB, malaria, STDs (public perspective) | 370 HIA 10,449 DALYs averted |
$-261/HIA $-16 ⋅ 55/DALY averted |
$-312/HIA $-19 ⋅ 80/DALY averted |
|||
| Robberstad et al. (2010) [50] | Single-dose NVPl | 0 ⋅ 00051 HIA (per pregnancy) 0 ⋅ 0129 DALYs averted |
$26,826/HIA $1,071/DALY averted |
$20,749/HIA $1,227/DALY averted |
NR | Tanzania: $1,090 ⋅ 00 |
| PMTCT Plusc | 0 ⋅ 00267 HIA (per pregnancy) 0 ⋅ 067 DALYs averted |
$7,204/HIA $287/DALY averted |
$8,257/HIA $328/DALY averted |
|||
| Shah et al. (2011) [51] | Current PMTCT Coverage (10% of all HIV-infected women) | 1400 HIA | $3,620/HIA | $4,149/HIA | 3% | Nigeria: $2,050 ⋅ 00 |
| Current ANC Coverage (58% of HIV-infected women) | 7680 HIA | $3,203/HIA | $3,671/HIA | |||
| Full PMTCT Coverage (100% of HIV-infected women) | 14400 HIA | $3,167/HIA | $3,630/HIA | |||
| Kuznik et al. (2012) [52] | 18 months ART vs. sdNVPl | 5 ⋅ 21 DALYs averted | $46/DALY averted | $51/DALY averted | 3% | Uganda: $717 ⋅ 50 |
| 18 months ART vs. DTl | 3 ⋅ 22 DALYs averted | $99/DALY averted | $110/DALY averted | |||
| 18 months ART vs. no treatment | 8 ⋅ 58 DALYs averted | $34/DALY averted | $37/DALY averted | |||
| Lifetime ART vs. sdNVP | 19 ⋅ 2 DALYs averted | $205/DALY averted | $228/DALY averted | |||
| Lifetime ART vs. DT | 11 ⋅ 87 DALYs averted | $354/DALY averted | $394/DALY averted | |||
| Lifetime ART vs. no treatment | 31 ⋅ 6 DALYs averted | $172/DALY averted | $191/DALY averted | |||
| Binagwaho et al. (2013) [53] | Dual ARV + breastfeeding | NR | Dominated | -- | 3% | Rwanda: $800 ⋅ 21 |
| Dual ARV + replacement feeding | NR | Dominated | -- | |||
| Sc-HAART + 6 mo. breastfeeding | NR | Dominated | -- | |||
| Sc-HAART + 12 mo. breastfeeding | 9,837 HIV uninfected children still alive | -- | -- | |||
| Sc-HAART + 18 mo. breastfeeding | 9,292 HIV uninfected children still alive | ICER = $11,882/HIA (compared to 12 mo.) | $12,882/HIA | |||
| Sc-HAART + replacement feeding | NR | Dominated | -- | |||
| Fasawe et al. (2013) [54] | Current Practice | 4,503 HIA | $816/HIA $37/QALY gained |
$935/HIA $42/QALY gained |
3% | Malawi: $349 ⋅ 13 |
| Option A | 15,606 HIA | $844/HIA $37/QALY gained |
$967/HIA $42/QALY gained |
|||
| Option B | 15,997 HIA | $1,331/HIA $60/QALY gained |
$1,525/HIA $68/QALY gained |
|||
| Option B + | 15,997 HIA | $1,265/HIA $57/QALY gained |
$1,450/HIA $65/QALY gained |
|||
| Maredza et al. (2013) [55] | Increase coverage of extended NVP to infants (rural) | 220 DALYs averted | Dominant | Dominant | 3% | South Africa: $6,560 ⋅ 00 |
| Promote formula feeding (rural) | 420 DALYs averted | $1,300/DALY averted | $1,490/DALY averted | |||
| Promote breastfeeding (rural) | 160 DALYs averted | Dominant | -- | |||
| Increase coverage of extended NVP to infants (urban) | 90 DALYs averted | Dominant | -- | |||
| Promote formula feeding (urban) | 160 DALYs averted | Dominant | -- | |||
| Promote breastfeeding (urban) | -240 DALYs avertedd | $3,200/DALY averted | $3,667/DALY averted | |||
| Gopalappa et al. (2014) [56] | Option B + vs. Option A | NRe | Kenya: $6,015/ HIA South Africa: $22,987/HIA Zambia: $6,778/HIA |
Kenya: $6,763/HIA South Africa: $25,590/HIA Zambia: $7,545/HIA |
3% | Kenya: $1,870 ⋅ 00 South Africa: $6,560 ⋅ 00 Zambia: $1,145 ⋅ 00 |
| Ishikawa et al. (2014) [57] | Option B | 7,176 HIA | $1,023/HIA | $1,094/HIA | 3% | Zambia: $1,145 ⋅ 00 |
| Option B + | 7,318 HIA | $1,254/HIA | $1,341/HIA | |||
| Yu et al. (2014) [58] | Remedy cohortf | 110 infant HIA | Extended dominatedg | -- | 3% | South Africa: $6,560 ⋅ 00 |
| Remedy cohort, breastfeed | 421 infant HIA | Extended dominated | -- | |||
| Remedy cohort, replacement feed | 11 infant HIA | Extended dominated | -- | |||
| Promptly treated cohorth | 698 infant HIA | Undominatedi | -- | |||
| Promptly treated cohort, breastfeed | 360 infant HIA | Extended dominated | -- | |||
| Promptly treated cohort, replacement feed | 883 infant HIA | Undominated | -- | |||
| Zulliger et al. (2014) [59] | Rapid initiation of ART in Pregnancy pilot program | 16.88 QALYs saved | $1,160/QALY gained | $1,291/QALY gained | 3% | South Africa: $6,560 ⋅ 00 |
| Price et al. (2016) [60] | Oral PrEP at first ANC visit with HIV- test and end with breastfeeding cessation | 381 HIA | $965/DALY averted | $1,025/DALY averted | 3% | Zambia: $1,145 ⋅ 00 |
| Tweya et al. (2016) [61] | Option B + vs. Option B | 133 DALYs averted | $841/DALY averted | $875/DALY averted | 3% | Malawi: $349 ⋅ 13 |
| Other biomedical | ||||||
| Verguet et al. (2010) [62] | Access to condoms and microbicide effective at 55% | 1,908 HIA | $-6,712/HIA | $-8,356/HIA | NR | South Africa: $6,560 ⋅ 00 |
| Williams et al. (2011) [63] | Tenofovir 25% Coverage | 250,000 HIA (20,000 – 380,000) | $2,392/HIA ($562-$4,222) | $2,662/HIA ($625-$4,700) | 3% | South Africa: $6,560 ⋅ 00 |
| Tenofovir 90% Coverage | 1,100,000 HIA (60,000 – 2,040,000) | $1,701/HIA ($420-$2,982) | $1,893/HIA ($467-$3,319) | |||
| Long et al. (2013) [64] | Scale-up of VMMC to 75% of all men | 12 ⋅ 1% HIA | Cost-saving | -- | NR | South Africa: $6,560 ⋅ 00 |
| Tenofovir gel used by 50% of women | 14 ⋅ 1% HIA | $526/QALY gained | $602/QALY gained | |||
| Use of PrEP by 50% of all uninfected persons | 28 ⋅ 4% HIA | $9,009/QALY gained | $10,326/QALY gained | |||
| VMMC, microbicide, and PrEP | 43 ⋅ 5% HIA | $5,739/QALY gained | $6,578/QALY gained | |||
| Mbah et al. (2013) [65] | Praziquantel treatment received during childhood | 21,120 HIA | $259/HIA | $314/HIA | 3% | Zimbabwe: $1,270 ⋅ 00 |
| Praziquantel treatment received during childhood and FGSl prevalence is reduced relative to those who did not receive treatment | 41,500 HIA | $132/HIA | $174/HIA | |||
| Terris-Prestholt et al. (2014) [66] | 72% microbicide gel use consistency and 54% HIV efficacy | 55,366 HIA | $297/DALY averted | $392/DALY averted | 3% | South Africa: $6,560 ⋅ 00 |
| Mvundura et al. (2015) [67] | Distribution of 100,000 female condoms | 273 HIA | Lower Bound: Cost Savingsj Higher Bound: $154/DALY avertedk |
-- Higher Bound: $168/DALY averted |
NR | SSA: $1,620 ⋅ 00 |
| Moodley et al. (2016) [68] | HIV vaccine intervention for school-based adolescents | 4 ⋅ 36 QALYs gained in lifetime | $43/QALY gained | $47/QALY gained | 3% | South Africa: $6,560 ⋅ 00 |
| Moodley et al. (2016) [69] | 60% coverage at $12 per vaccine dose | NR | $4 ⋅ 98/LYG (95%: $2 ⋅ 77–$11 ⋅ 61) | $5 ⋅ 45/LYG (95%: $3 ⋅ 03–$12 ⋅ 70) | 3% | South Africa: $6,560 ⋅ 00 |
| Wall et al. (2018) [70] | Nationwide CVCT | 166,153 HIA | $394/HIA | $394/HIA | 0% | Zambia: $1,145 ⋅ 00 |
| TasP for serodiscordant couples identified by CVCT | 9,656 HIA | $7,930/HIA | $7,930/HIA | |||
| Population TasP for all HIV + cohabitating men and women identified by individual HTC | 17,872 HIA | $12,891/HIA | $12,891/HIA | |||
| Behaviour change | ||||||
| Enns et al. (2011) [71] | Increased monogamy | 77 (8 ⋅ 7%) HIA | NR | -- | 3% | Eswatini: $4,090 ⋅ 00 Tanzania: $1,090 ⋅ 00 Uganda: $717 ⋅ 50 Zambia: $1,145 ⋅ 00 |
| High-risk partnership reduction | 115 (11 ⋅ 7%) HIA | NR | -- | |||
| Untargeted partnership reduction | 76 (8 ⋅ 9%) HIA | NR | -- | |||
| Structural | ||||||
| Fieno et al. (2014) [72] | Cash transfer at $5 monthly benefit | 3,400 HIA | $1,650/HIA | $1,919/HIA | NR | South Africa: $6,560 ⋅ 00 |
| Cash transfer at $10 monthly benefit | 4,250 HIA | $2,640/HIA | $3,071/HIA | |||
| Cash transfer at $20 monthly benefit | 5,100 HIA | $4,400/HIA | $5,118/HIA | |||
| Remme et al. (2014) [73] | Long-term benefits of 18-month cash transfer trial | 93,600 HIV DALYs averted | $297/HIV DALY averted | $345/HIV DALY averted | NR | Malawi: $349 ⋅ 13 |
| Rutstein et al. (2014) [74] | Passive Referral | Ref. | Ref. | -- | NR | Malawi: $349 ⋅ 13 |
| Provider Notification | 27 ⋅ 5 HIA | ICER = $3,560/HIA | $4,080/HIA | |||
| Contract Notification | 0 ⋅ 4 HIA | ICER = $51,421/HIA | $58,941/HIA | |||
a
Country GDP estimates retrieved from International Monetary Fund, World Economic Outlook.
b
ART coverage means HIV treatment for people with CD4 < 350 cells/μL and TasP coverage means HIV treatment for people with CD4 ≥ 350 cells/μL.
c
PMTCT Plus refers to a HAART intervention for all HIV infected women during pregnancy and lactation, regardless of CD4 count, according to 2009 WHO guidelines.
d
Negative value indicates an intervention was less effective than base case.
e
Not reported for infant only infections averted.
f
Women in remedy cohort received HIV testing and standard treatment only after delivery.
g
Extended dominated excludes any intervention that has a higher ICER than more effective interventions.
h
Women in the promptly treated cohort received HIV testing and treatment at some point during pregnancy.
i
Undominated refers to strategies that are more cost-effective.
j
The intervention was cost-saving in the following countries: Botswana, South Africa, Eswatini, Zambia, Zimbabwe.
k
Cost($)/DALY averted for other included countries: Cameroon (43), Kenya (110), Lesotho (9), Malawi (114), Mozambique (154), Namibia (9), Tanzania (73), Uganda (25).
l
Abbreviations: DT = dual therapy (zidovudine and lamivudine); ANC = antenatal care clinic; ARV = antiretrovirals; ART = antiretroviral therapy; CI = confidence intervals; DALY = disability-adjusted life year; EIMC = early infant male circumcision; FGS = female genital schistosomiasis; FSW = female sex worker; HAART = highly-active antiretroviral therapy; HIA = HIV infections averted; LYG = life years gained; NVP = nevirapine; PMTCT = prevention of mother-to-child transmission; PrEP = pre-exposure prophylaxis; QALY = quality-adjusted life year; Sc-HAART = short-course highly-active antiretroviral therapy; sdNVP = single dose nevirapine; SSA = sub-Saharan Africa; STD = sexually transmitted disease; TB = tuberculosis; UNGASS = UN General Assembly Special Session on AIDS; VCT = voluntary counselling and testing; VMMC = voluntary medical male circumcision; yo = years old.
m
Abbreviations: NR = not reported; in certain instances, studies may have 1) reported cost-effectiveness measure without stating an effectiveness measure or 2) presented visualized cost-effectiveness results without stating the numeric value of the cost-effectiveness measure. These instances would lead to an ‘NR’.