aFutures Institute, Glastonbury, Connecticut, USA bWorld Health Organization cUNAIDS, Geneva, Switzerland.
AIDS. 2014 Jan;28 Suppl 1:S5-14. doi: 10.1097/QAD.0000000000000083.
Most countries follow WHO 2010 guidelines for the prevention of mother-to-child transmission (PMTCT) of HIV using either Option A or B for women not yet eligible for antiretroviral therapy (ART). Both of these approaches involve the use of antiretrovirals during pregnancy and breastfeeding. Some countries have adopted a new strategy, Option B+, in which HIV-positive pregnant women are started immediately on ART and continued for life. Option B+ is more costly than Options A or B, but provides additional health benefits. In this article, we estimate the additional costs and effectiveness of Option B+.
We developed a deterministic model to simulate births, breastfeeding, and HIV infection in women in four countries, Kenya, Zambia, South Africa, and Vietnam that differ in fertility rate, birth interval, age at first birth, and breastfeeding patterns, but have similar age at HIV infection. We estimated the total PMTCT costs and new child infections under Options A, B, and B+, and measured cost-effectiveness as the incremental PMTCT-related costs per child infection averted. We included adult sexual transmissions averted from ART, the corresponding costs saved, and estimated the total incremental cost per transmission (child and adult) averted.
When considering PMTCT-related costs and child infections, Option B+ was the most cost-effective strategy costing between $6000 and $23 000 per infection averted compared with Option A. Option B+ averted more child infections compared with Option B in all four countries and cost less than Option B in Kenya and Zambia. When including adult sexual transmissions averted, Option B+ cost less and averted more infections than Options A and B.
大多数国家遵循世界卫生组织 2010 年的指南，对尚未符合抗逆转录病毒治疗（ART）条件的妇女采用方案 A 或方案 B 进行预防母婴传播（PMTCT）艾滋病毒。这两种方法都涉及在怀孕和哺乳期使用抗逆转录病毒药物。一些国家采用了一种新策略，即方案 B+，其中 HIV 阳性孕妇立即开始接受 ART，并终身持续使用。方案 B+比方案 A 或方案 B 更昂贵，但提供了额外的健康益处。在本文中，我们估计了方案 B+的额外成本和效果。
我们开发了一个确定性模型，以模拟在肯尼亚、赞比亚、南非和越南这四个国家中生育、母乳喂养和 HIV 感染的情况。这四个国家的生育率、生育间隔、首次生育年龄和母乳喂养模式不同，但 HIV 感染年龄相似。我们估计了方案 A、B 和 B+的总 PMTCT 成本和新的儿童感染，并将每例儿童感染避免的增量 PMTCT 相关成本作为成本效益的衡量标准。我们包括了从 ART 中避免的成人性传播，相应节省的成本，并估计了每例（儿童和成人）避免的总增量成本。
在考虑 PMTCT 相关成本和儿童感染时，方案 B+是最具成本效益的策略，每例感染的成本在 6000 美元至 23000 美元之间，优于方案 A。在所有四个国家中，方案 B+比方案 B 避免了更多的儿童感染，在肯尼亚和赞比亚，方案 B+的成本也低于方案 B。当包括避免的成人性传播时，方案 B+的成本低于方案 A 和方案 B，并且避免了更多的感染。
