Nuwamanya Elly, Johnson Benjamin C, Okoboi Stephen, Galiwango Ronald, Namuddu Diana, Ayabo Tabitha, Babigumira Joseph B, Lamorde Mohammed
Infectious Diseases Institute, College of Health Sciences, Makerere University, P.O Box 22418, Kampala, Uganda.
Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Pharmacoecon Open. 2025 Jun 8. doi: 10.1007/s41669-025-00587-x.
BACKGROUND: Novel retention strategies have the potential to reduce vertical transmission of HIV and improve patient outcomes for women living with HIV (WLHIV) and their infants. We estimated the budget impact of the enhanced retention strategy (ERS) compared with the Ministry of Health strategy/standard of care (SOC) approach for preventing vertical transmission of HIV among women initiating antiretroviral therapy (ART) in late pregnancy in Uganda. METHODS: A budget impact analysis (BIA) was conducted from the payer (Uganda's Ministry of Health) perspective with a 5-year time horizon. A Microsoft Excel-based BIA model was populated with HIV epidemiological data and expenditures from the literature and the clinical trial of dolutegravir in pregnant HIV mothers and their neonates. These cost projections accounted for various programmatic inputs, disease progression, differences in mortality based on treatment status, and subsequent pregnancies. The eligible population included all HIV-positive pregnant women currently receiving prevention of vertical transmission services in Uganda. The primary outcomes of the analysis were incremental budget costs, and infections averted over 5 years. RESULTS: Adopting the ERS would lead to a net cost increase of US$63.8 million over the next 5 years, or a net cost increase of US$12.7 million per year compared with the SOC. Newly enrolled WLHIV accounts for US$39.5 million of these marginal costs, while in-system patients account for US$24.2 million. Direct programmatic costs of the ERS only account for 13% of this additional cost, with 87% of the marginal increase coming from the cost of providing ART for WLHIV who would otherwise be lost to follow-up. The ERS would avert an additional 6933 infant infections compared with the SOC. CONCLUSION: Implementing the ERS would significantly increase the Ugandan Ministry of Health's budget, but most additional costs would be accrued from the resulting expansion of ART client volume. The ERS is a relatively low-cost intervention to reduce loss to follow-up rates among marginalized and hard-to-reach populations.
背景：新型留存策略有可能减少艾滋病毒的垂直传播，并改善感染艾滋病毒的妇女（WLHIV）及其婴儿的治疗效果。我们估计了强化留存策略（ERS）与乌干达卫生部策略/标准治疗（SOC）方法相比，对晚期妊娠开始接受抗逆转录病毒治疗（ART）的妇女预防艾滋病毒垂直传播的预算影响。 方法：从支付方（乌干达卫生部）的角度进行了一项为期5年的预算影响分析（BIA）。基于微软Excel的BIA模型使用了艾滋病毒流行病学数据以及来自文献和多替拉韦在感染艾滋病毒的孕妇及其新生儿中的临床试验的支出数据。这些成本预测考虑了各种项目投入、疾病进展、基于治疗状态的死亡率差异以及后续妊娠情况。符合条件的人群包括乌干达目前正在接受垂直传播预防服务的所有艾滋病毒阳性孕妇。分析的主要结果是增量预算成本以及5年内避免的感染病例数。 结果：与SOC相比，采用ERS在未来五年将导致净成本增加6380万美元，即每年净成本增加1270万美元。新登记的WLHIV占这些边际成本的3950万美元，而系统内患者占2420万美元。ERS的直接项目成本仅占这一额外成本的13%，边际增加成本的87%来自为否则会失访的WLHIV提供抗逆转录病毒治疗的成本。与SOC相比，ERS将额外避免6933例婴儿感染。 结论：实施ERS将显著增加乌干达卫生部的预算，但大部分额外成本将来自抗逆转录病毒治疗服务对象数量的相应增加。ERS是一种相对低成本的干预措施，可降低边缘化和难以接触人群的失访率。
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