Table 3.
Health effect and cost-effectiveness of maternal HIV and syphilis testing scenarios
| Total costs (US$) | Total HIV infections | Total syphilis infections | Total DALYs* | Incremental costs (US$) | Incremental DALYs averted | ICER† | Comparator | |
|---|---|---|---|---|---|---|---|---|
| Kenya | ||||||||
| Base case | $62 924 984 | 13 468 | 18 832 | 1 030 415 | .. | .. | .. | .. |
| Scenario one | $62 671 902 | 13 470 | 15 827 | 1 020 644 | −$253 082 | 9770 | −$26‡ | Base case |
| Scenario two | $67 356 499 | 10 943 | 18 832 | 1 015 467 | $4 684 597 | 5177 | Dom | .. |
| Scenario three | $66 707 622 | 10 944 | 15 827 | 1 005 693 | $4 035 720 | 14 951 | $270§ | Scenario one |
| South Africa | ||||||||
| Base case | $151 601 450 | 27 012 | 12 257 | 745 434 | .. | .. | .. | .. |
| Scenario one | $146 367 385 | 27 017 | 9348 | 736 077 | −$5 234 065 | 9358 | −$559‡ | Base case |
| Scenario two | $162 156 341 | 23 829 | 12 257 | 727 129 | $15 788 956 | 8947 | Dom | .. |
| Scenario three | $151 135 725 | 23 834 | 9348 | 717 766 | $4 768 340 | 18 311 | $260§ | Scenario one |
| Colombia | ||||||||
| Base case | $5 855 930 | 145 | 1281 | 73 133 | .. | .. | .. | .. |
| Scenario one | $4 794 810 | 145 | 878 | 71 875 | −$1 061 120 | 1258 | −$844‡ | Base case |
| Scenario two | $9 279 059 | 122 | 916 | 71 842 | $4 484 248 | 33 | Dom | .. |
| Scenario three | $7 295 786 | 122 | 564 | 70 742 | $2 500 976 | 1133 | $2207§ | Scenario one |
| Ukraine | ||||||||
| Base case | $8 801 528 | 71 | 2333 | 54 818 | .. | .. | .. | .. |
| Scenario one | $7 902 302 | 71 | 1694 | 52 837 | −$899 226 | 1980 | −$454‡ | Base case |
| Scenario two | $10 327 010 | 67 | 890 | 50 432 | $2 424 707 | 2405 | Dom | .. |
| Scenario three | $8 588 217 | 67 | 593 | 49 486 | $685 914 | 3352 | $205§ | Scenario one |
Base case used independent tests specific to each setting. Scenario one used dual HIV and syphilis testing with no retesting during late ANC. Scenario two used independent HIV and syphilis tests with retesting during late ANC. Scenario three used dual HIV and syphilis testing with retesting during late ANC. ANC=antenatal care. DALY=disability-adjusted life-year. ICER=incremental cost-effectiveness ratio. Dom=dominated (more costly and less effective than dominating scenario).
DALYs averted and incremental costs are compared with the next most effective (by DALYs) scenario. Individual tests are HIV rapid tests and rapid plasma regain tests for syphilis; Treponema pallidum hemagglutination assay used for confirmatory syphilis testing for reactive rapid plasma regain results. Reactive rapid HIV tests and dual HIV tests confirmed with an additional HIV rapid test.
Calculated as incremental costs (in 2017 US$) divided by DALYs averted compared with the next most effective (by DALYs) scenario, with dominated scenarios removed.
Indicates scenario is cost-saving.
Indicates scenario is cost-effective compared to country-specific cost-effectiveness threshold.