AEGiS-13IAC: Modelling the cost effectiveness (CE) of prevention strategies for mother-to-child HIV transmission (MTCT) in Mexico.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Modelling the cost effectiveness (CE) of prevention strategies for mother-to-child HIV transmission (MTCT) in Mexico.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. WeOrC615)

Rely K, Bertozzi S
K. Rely, National Institute of Public Health, Av. Universidad 655, Cuernavaca, Morelos 62508, Mexico, Tel.: +52 7 311 37 83, Fax: +52 7 311 11 56, E-mail: rkely@insp.mx

OBJECTIVE: To estimate CE of interventions to reduce MTCT in Mexico using an adaptation of a model developed by J Stover. Material and

METHOD: We examine five different scenarios, each with different combination of interventions to reduce MTCT and each estimated using both zidovudine (ZDV) and nevirapine (NVP). They differ according to coverage, type of counselling and testing (VCT), whether restricted to women at higher risk, and whether rapid testing is offered at delivery to women without prenatal care. The results are reported as cost per child infection prevented (C/CIP). Savings due to averted treatment costs and adult infections averted due to VCT are also estimated.

RESULTS: Among 120,000 women attending public antenatal clinics, increasing VCT coverage from 4% to 85% would prevent 13 paediatric and 3 adult infections annually at a C/CIP of US$ 41,560 using ZDV. In the most restrictive scenario, with limited VCT, 7 paediatric infections are prevented with a C/CIP of $ 21,693. Use of NVP appears to increase C/CIP because the reduced drug cost is more than offset by its reduced effectiveness.

CONCLUSION: MTCT treatment for known HIV-positive women appears to be cost savings. The most effective treatment option also seems to be most cost-effective. However, programs that not only offers treatment but also detect HIV positive women, result in relatively high C/CIP due to the low HIV prevalence among Mexican women. These costs may be able to be reduced by almost 50% if VCT were performed with group pre-test counseling and with post-test counseling only for positive women. The decision about whether or not to initiate such a program may well differ among the different Mexican health systems that cater to different socio-economic strata of the population. Any such decision will also need to consider the community benefits (increased awareness, reduced stigma, etc.) that result from initiating such a program and that have not been modeled in this exercise.

Keywords: AEGIS, HIV Infections, Zidovudine, Cost-Benefit Analysis, Nevirapine, Mothers, Prenatal Care, Counseling, HIV Seropositivity, Delivery, Obstetric, Mexico, Child, Human, Female, Adult, transmission, economics, surgery
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