Werayingyong Pitsaphun, Phanuphak Nittaya, Chokephaibulkit Kulkunya, Tantivess Sripen, Kullert Nareeluk, Tosanguan Kakanang, Butchon Rukmanee, Voramongkol Nipunporn, Boonsuk Sarawut, Pilasant Songyot, Kulpeng Wantanee, Teerawattananon Yot
Health Intervention and Technology Assessment Program, Nonthaburi, Thailand
The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
Asia Pac J Public Health. 2015 Mar;27(2):NP866-76. doi: 10.1177/1010539513489134. Epub 2013 May 30.
The current program for prevention of mother-to-child HIV transmission in Thailand recommends a 2-drugs regimen for HIV-infected pregnant women with a CD4 count >200 cells/mm(3). This study assesses the value for money of 3 antiretroviral drugs compared with zidovudine (AZT)+single-dose nevirapine (sd-NVP). A decision tree was constructed to predict costs and outcomes using the governmental perspective for assessing cost-effectiveness of 3-drug regimens: (1) AZT, lamivudine, and efavirenz and (2) AZT, 3TC, and lopinavir/ritonavir, in comparison with the current protocol, AZT+sd-NVP. The 3-drug antiretroviral regimens yield lower costs and better health outcomes compared with AZT+sd-NVP. Although these 3-drug regimens offer higher program costs and health care costs for premature birth, they save money significantly in regard to pediatric HIV treatment and treatment costs for drug resistance in mothers. The 3-drug regimens are cost-saving interventions. The findings from this study were used to support a policy change in the national recommendation.
泰国目前的预防母婴传播艾滋病毒项目建议，对于CD4细胞计数>200个/立方毫米的感染艾滋病毒的孕妇采用双药疗法。本研究评估了三种抗逆转录病毒药物与齐多夫定（AZT）加单剂量奈韦拉平（sd-NVP）相比的性价比。构建了一个决策树，从政府角度预测成本和结果，以评估三种药物疗法的成本效益：（1）AZT、拉米夫定和依非韦伦，以及（2）AZT、3TC和洛匹那韦/利托那韦，并与当前方案AZT+sd-NVP进行比较。与AZT+sd-NVP相比，三种药物的抗逆转录病毒疗法成本更低，健康结果更好。虽然这三种药物疗法会因早产带来更高的项目成本和医疗成本，但在儿科艾滋病毒治疗和母亲耐药性治疗成本方面能显著节省资金。三种药物疗法是节省成本的干预措施。本研究结果被用于支持国家建议中的政策变化。
