AEGiS-14IAC: Reducing mother to child transmission of HIV-1 in Barbados. Cost-effectiveness of the PACTG 076 protocol in a middle income, low prevalence setting.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

Reducing mother to child transmission of HIV-1 in Barbados. Cost-effectiveness of the PACTG 076 protocol in a middle income, low prevalence setting.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. LbPp2210)

Adomakoh S, Kumar A, St. John A
University of the West Indies, School of Clinical Medicine and Research, St. Michael, Barbados

BACKGROUND: Eastern Caribbean governments have identified PMTCT, as the most urgently required HIV prevention intervention. We estimate cost-effectiveness of PMTCT using the PACTG076 protocol in Barbados and use estimates generated toproduce a model to assess the cost effectiveness under varied treatment settings.

METHODS: Mother - baby pairs given Zidovudine (ZDV) and those not given ZDV between the periods January 1993 to Dec 1998 were studied. Costs associated with identification of HIV-1 infected pregnant women, prevention of transmission, and treatment of all newborns were identified. Childhood HIV-related medical costs were also collected. Costs were calculated at a discount rate of 3% to allow for time preference.

RESULTS: Lifetime cost of treating an HIV infected child is US$8665. At 0.9% HIV-1 sero-prevalence, screening uptake of 75%, and 14 weeks median duration on ZDV, the PACT076 protocol costs $145,883, averts 26 cases, is cost-saving at a net cost of ($78,149) and generates 2075 DALYS. The intervention ceases to be cost-saving, yet is still highly cost effective, at HIV-1 prevalence rates below 0.5%. At 0.5% sero-prevalence, the intervention averts 14 cases at a net cost of $3873, cost per case averted of $276, generates 1128 DALYS at $3.43 per DALY. Consideration of amortised training costs has no significant effect on cost-effectiveness. When a long course (20 weeks) antenatal duration on ZDV is considered, the regimen is most effective, yet significantly more costly than the observed duration.

CONCLUSION: Universal screening and PMTCT of HIV-1 using the modified PACTG076 protocol is highly cost-effective in the Barbadian setting. The moderately shortened duration on ZDV compared with the long-course of 20 weeks allows for the maintenance of cost-effectiveness under a wide range of HIV-1 sero-prevalence, uptake and treatment acceptance rates. This is so even in settings where training and programme set- up costs will be observed.

Keywords: AEGIS, HIV-1, Prevalence, Zidovudine, Cost-Benefit Analysis, HIV Infections, Mothers, Income, Mass Screening, Barbados, Caribbean Region, Child, Human, Infant, Infant, Newborn, Pregnancy, Female, transmission, epidemiology, economics

020707
LbPp2210