Tweya Hannock, Keiser Olivia, Haas Andreas D, Tenthani Lyson, Phiri Sam, Egger Matthias, Estill Janne
aThe International Union Against Tuberculosis and Lung Disease, Paris, France bLighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi cInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland dDepartment of HIV and AIDS, Ministry of Health, Lilongwe, Malawi eInternational Training and Education Center for Health, University of Washington, Seattle, Washington, USA fCentre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
AIDS. 2016 Mar 27;30(6):953-62. doi: 10.1097/QAD.0000000000001009.
To estimate the cost-effectiveness of prevention of mother-to-child transmission (MTCT) of HIV with lifelong antiretroviral therapy (ART) for pregnant and breastfeeding women ('Option B+') compared with ART during pregnancy or breastfeeding only unless clinically indicated ('Option B').
Mathematical modelling study of first and second pregnancy, informed by data from the Malawi Option B+ programme.
Individual-based simulation model. We simulated cohorts of 10 000 women and their infants during two subsequent pregnancies, including the breastfeeding period, with either Option B+ or B. We parameterized the model with data from the literature and by analysing programmatic data. We compared total costs of antenatal and postnatal care, and lifetime costs and disability-adjusted life-years of the infected infants between Option B+ and Option B.
During the first pregnancy, 15% of the infants born to HIV-infected mothers acquired the infection. With Option B+, 39% of the women were on ART at the beginning of the second pregnancy, compared with 18% with Option B. For second pregnancies, the rates MTCT were 11.3% with Option B+ and 12.3% with Option B. The incremental cost-effectiveness ratio comparing the two options ranged between about US$ 500 and US$ 1300 per DALY averted.
Option B+ prevents more vertical transmissions of HIV than Option B, mainly because more women are already on ART at the beginning of the next pregnancy. Option B+ is a cost-effective strategy for PMTCT if the total future costs and lost lifetime of the infected infants are taken into account.
评估对孕妇和哺乳期妇女采用终身抗逆转录病毒疗法（ART）预防母婴传播（MTCT）（“方案B+”）与仅在孕期或哺乳期有临床指征时采用ART（“方案B”）相比的成本效益。
基于马拉维方案B+项目数据的首次和第二次妊娠数学建模研究。
基于个体的模拟模型。我们模拟了10000名妇女及其婴儿在随后两次妊娠（包括哺乳期）期间采用方案B+或方案B的队列。我们用文献数据和通过分析项目数据对模型进行参数化。我们比较了方案B+和方案B之间产前和产后护理的总成本、感染婴儿的终身成本和伤残调整生命年。
在首次妊娠期间，感染艾滋病毒母亲所生婴儿中有15%感染了该病毒。采用方案B+时，39%的妇女在第二次妊娠开始时接受ART治疗，而采用方案B时这一比例为18%。对于第二次妊娠，方案B+的MTCT率为11.3%，方案B为12.3%。比较这两种方案的增量成本效益比在每避免一个伤残调整生命年约500美元至1300美元之间。
方案B+比方案B预防更多的艾滋病毒垂直传播，主要是因为更多妇女在下一次妊娠开始时已接受ART治疗。如果考虑到感染婴儿未来的总成本和终身损失，方案B+是预防母婴传播的一种具有成本效益的策略。
