AEGiS-13IAC: Costs and benefits of a vertical transmission prevention program in the Dominican Republic.

13th International AIDS Conference

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

Costs and benefits of a vertical transmission prevention program in the Dominican Republic.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. WeOrC616)

Butler M, Perez E, Bollinger L, Colvin C
M. Butler, Procets, Calle Mahatma Gandhi No. 351, Apartado 2882, Santo Domingo, Republica Dominicana, Dominican Republic, Tel.: +809 688 58 10, Fax: +809 686 76 97, E-mail: fund.genesis@codetel.net.do

More than 90 percent of pediatric AIDS cases are caused by the vertical transmission of HIV from mother to child. Various treatment options are available to reduce the rate of vertical transmission, including administering either zidovudine or nevirapine, undergoing a planned Cesarean section at the time of delivery, and using artificial feeding methods after birth. This report presents the results of a cost-benefit analysis performed in a series of workshops during October 1999, to evaluate a program to prevent mother-to-child transmission (MTCT) of HIV in the Dominican Republic. The model includes consideration of costs such as counseling and testing, drugs, Cesarean sections, and formula, as well as benefits such as user fees and savings on treatment costs. Key policy decisions include variables such as the percentage of pregnant women offered treatment, as well as the type of treatments offered. Sensitivity analyses were performed to ascertain the effect of changes in critical assumptions.

RESULTS: Indicate that this program is an excellent option for the government. The initial scenario, where all HIV+ women receive nevirapine therapy, planned Cesarean section births, and six months of formula, results in a benefit-cost ratio of 1.63, with 468 child deaths prevented. Since a large percentage of the costs consist of formula costs, an alternative scenario was calculated, where all HIV+ women still receive nevirapine and C-sections, but the government pays for only half of the formula costs, while the other half is donated by private firms or international donors. This increases the benefit-cost ratio to 2.94, so that for every peso the government spends on the program, it will save almost 3 pesos over the long run. Each of these scenarios shows that a vertical transmission prevention program is an efficient investment of government resources.

Keywords: AEGIS, Disease Transmission, Vertical, Zidovudine, Nevirapine, HIV Infections, Cesarean Section, Delivery, Obstetric, Cost-Benefit Analysis, HIV Seropositivity, Prenatal Care, Counseling, Dominican Republic, Human, Female, Pregnancy, Child, Education, transmission, surgery, economics, therapy
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WeOrC616