Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, 23219, USA; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA.
The University of Kinshasa, School of Public Health, Kinshasa, Democratic Republic of the Congo, The.
Soc Sci Med. 2023 Mar;320:115684. doi: 10.1016/j.socscimed.2023.115684. Epub 2023 Jan 14.
BACKGROUND: Prevention of mother-to-child transmission (PMTCT) is critical for halting the HIV epidemic. However, innovative approaches to improve PMTCT uptake may be resource-intensive. We examined the economic costs and cost-effectiveness of conditional cash transfers (CCTs) for the uptake of PMTCT services in the Democratic Republic of Congo. METHODS: We leveraged data from a randomized controlled trial of CCTs (n = 216) versus standard PMTCT care alone (standard of care (SOC), n = 217). Economic cost data came from multiple sources, with costs analyzed from the societal perspective and reported in 2016 international dollars (I$). Effectiveness outcomes included PMTCT uptake (i.e., accepting all PMTCT visits and services) and retention (i.e., in HIV care at six weeks post-partum). Generalized estimating equations estimated effectiveness (relative risk) and incremental costs, with incremental effectiveness reported as the number of women needing CCTs for an additional PMTCT uptake or retention. We evaluated the cost-effectiveness of the CCTs at various levels of willingness-to-pay and assessed uncertainty using deterministic sensitivity analysis and cost-effectiveness acceptability curves. RESULTS: Mean costs per participant were I$516 (CCTs) and I$431 (SOC), representing an incremental cost of I$85 (95% CI: 59, 111). PMTCT uptake was more likely for CCTs vs SOC (68% vs 53%, p < 0.05), with seven women needing CCTs for each additional PMTCT service uptake; twelve women needed CCTs for an additional PMTCT retention. The incremental cost-effectiveness of CCTs vs SOC was I$595 (95% CI: I$550, I$638) for PMTCT uptake and I$1028 (95% CI: I$931, I$1125) for PMTCT retention. CCTs would be an efficient use of resources if society's willingness-to-pay for an additional woman who takes up PMTCT services is at least I$640. In the worst-case scenario, the findings remained relatively robust. CONCLUSIONS: Given the relatively low cost of the CCTs, policies supporting CCTs may decrease onward HIV transmission and expedite progress toward ending the epidemic.
背景：预防母婴传播（PMTCT）对于阻止艾滋病毒的传播至关重要。然而，为提高 PMTCT 的接受率而采取的创新方法可能需要大量资源。我们研究了在刚果民主共和国实施有条件现金转移（CCT）对 PMTCT 服务利用的经济成本和成本效益。
方法：我们利用了一项 CCT 随机对照试验（n=216）与单独标准 PMTCT 护理（标准护理（SOC），n=217）的数据。经济成本数据来自多个来源，从社会角度进行了成本分析，并以 2016 年国际元（I$）报告。效果结果包括 PMTCT 的利用（即接受所有 PMTCT 就诊和服务）和保留（即产后六周时留在 HIV 护理中）。广义估计方程估计了效果（相对风险）和增量成本，并将增量效果报告为需要 CCT 的妇女数量，以提高 PMTCT 的利用或保留率。我们在不同的支付意愿水平上评估了 CCT 的成本效益，并通过确定性敏感性分析和成本效益可接受性曲线评估了不确定性。
结果：每位参与者的平均成本为 I$516（CCTs）和 I$431（SOC），代表 I$85 的增量成本（95%置信区间：59，111）。与 SOC 相比，CCT 更有可能提高 PMTCT 的利用率（68%对 53%，p<0.05），每增加一项 PMTCT 服务，就需要 7 名妇女接受 CCT；每增加一名妇女接受 PMTCT 保留，就需要 12 名妇女接受 CCT。与 SOC 相比，CCT 在 PMTCT 利用率上的增量成本效益为 I$595（95%置信区间：I$550，I$638），在 PMTCT 保留上的增量成本效益为 I$1028（95%置信区间：I$931，I$1125）。如果社会对接受 PMTCT 服务的妇女的支付意愿至少为 I$640，则 CCT 将是资源的有效利用。在最坏的情况下，研究结果仍然相对稳健。
结论：鉴于 CCT 的成本相对较低，支持 CCT 的政策可能会减少艾滋病毒的进一步传播，并加速实现终结疫情的目标。
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