Söderlund N, Zwi K, Kinghorn A, Gray G
Centre for Health Policy, University of the Witwatersrand PO Box 1038, Johannesburg 2000, South Africa.
BMJ. 1999 Jun 19;318(7199):1650-6. doi: 10.1136/bmj.318.7199.1650.
To assess the cost effectiveness of vertical transmission prevention strategies by using a mathematical simulation model.
A Markov chain model was used to simulate the cost effectiveness of four formula feeding strategies, three antiretroviral interventions, and combined formula feeding and antiretroviral interventions on a cohort of 20 000 pregnancies. All children born to HIV positive mothers were followed up until age of likely death given current life expectancy and a cost per life year gained calculated for each strategy.
Model of working class, urban South African population.
Low cost antiretroviral regimens were almost as effective as high cost ones and more cost effective when formula feeding interventions were added. With or without formula feeding, low cost antiretroviral interventions were likely to save lives and money. Interventions that allowed breast feeding early on, to be replaced by formula feeding at 4 or 7 months, seemed likely to save fewer lives and offered poorer value for money.
Antiretroviral interventions are probably cost effective across a wide range of settings, with or without formula feeding interventions. The appropriateness of formula feeding was highly cost effective only in settings with high seroprevalence and reasonable levels of child survival and dangerous where infant mortality was high or the protective effect of breast feeding substantial. Pilot projects are now needed to ensure the feasibility of implementation.
通过使用数学模拟模型评估垂直传播预防策略的成本效益。
采用马尔可夫链模型，对20000例妊娠队列中的四种配方奶喂养策略、三种抗逆转录病毒干预措施以及配方奶喂养与抗逆转录病毒干预措施相结合的情况进行成本效益模拟。对所有感染艾滋病毒的母亲所生儿童进行随访，直至根据当前预期寿命达到可能死亡的年龄，并计算每种策略每获得一个生命年的成本。
南非城市工人阶级人群模型。
低成本抗逆转录病毒治疗方案几乎与高成本方案一样有效，并且在添加配方奶喂养干预措施时更具成本效益。无论有无配方奶喂养，低成本抗逆转录病毒干预措施都可能挽救生命并节省资金。早期允许母乳喂养、在4个月或7个月时改用配方奶喂养的干预措施似乎挽救的生命较少，性价比也较低。
无论有无配方奶喂养干预措施，抗逆转录病毒干预措施在广泛的环境中可能都具有成本效益。仅在血清阳性率高、儿童存活率合理的环境中，配方奶喂养的适宜性才具有高度成本效益，而在婴儿死亡率高或母乳喂养保护作用显著的环境中则存在风险。现在需要开展试点项目以确保实施的可行性。
