Center for International Health, University of Bergen, Bergen, Norway.
J Acquir Immune Defic Syndr. 2010 Nov;55(3):397-403. doi: 10.1097/QAI.0b013e3181eef4d3.
Recent guidelines recommend that all HIV-infected women should receive highly active antiretroviral therapy throughout pregnancy and lactation, irrespective of whether or not they need it for their own health. This strategy for prevention of mother to child transmission (PMTCT) of HIV is more effective than the well-established use of single-dose nevirapine, but it is also a more costly alternative. In this economic evaluation, we use a decision model to combine the best available clinical evidence with cost, epidemiological and behavioral data from Northern Tanzania. We find that a highly active antiretroviral therapy-based PMTCT Plus regimen is more cost effective than the current Tanzanian standard of care with single-dose nevirapine. Although PMTCT Plus is roughly 40% more expensive per pregnant woman than single-dose nevirapine, the expected health benefits are 5.2 times greater. The incremental cost effectiveness ratio of the PMTCT Plus intervention is calculated to be 4062 USD per child infection averted and 162 USD per disability adjusted life year.
最近的指南建议，所有感染 HIV 的孕妇都应在整个孕期和哺乳期接受高效抗逆转录病毒治疗，无论她们自身的健康状况是否需要。这种预防母婴传播（PMTCT）的策略比已确立的单剂量奈韦拉平的使用更为有效，但成本也更高。在这项经济评估中，我们使用决策模型将最佳临床证据与来自坦桑尼亚北部的成本、流行病学和行为数据结合起来。我们发现，基于高效抗逆转录病毒治疗的 PMTCT Plus 方案比目前使用单剂量奈韦拉平的坦桑尼亚标准治疗更为经济有效。尽管 PMTCT Plus 每个孕妇的费用比单剂量奈韦拉平高出约 40%，但预期的健康收益要高出 5.2 倍。PMTCT Plus 干预措施的增量成本效益比为每避免一例儿童感染 4062 美元，每避免一例残疾调整生命年 162 美元。
