Ratcliffe J, Ades A E, Gibb D, Sculpher M J, Briggs A H
Health Economics Research Group, Brunel University, Uxbridge, UK.
AIDS. 1998 Jul 30;12(11):1381-8. doi: 10.1097/00002030-199811000-00021.
To estimate the cost-effectiveness of alternative interventions to reduce the risk of mother-to-child transmission of HIV.
A model capturing the sequential nature of mother-to-child transmission in utero, at delivery and postnatally was used to determine how the effects of bottle-feeding, elective Cesarean section (CS) and zidovudine (ZDV) would combine to prevent mother-to-child HIV transmission. Parameter estimates were derived from the literature, UK health service costs applied, and incremental cost effectiveness ratios (ICER) estimated for alternative risk reduction strategies. Results can be transposed to other cost assumptions or currencies.
In a woman who breast-feeds her baby, has a vaginal or emergency CS delivery and takes no ZDV, the estimated transmission risk is 31.6% (range, 23.7-38.1%), at a cost of 400 UK pound per woman; this falls to a risk of 3.7% (range, 1.7-6.9%) when bottle-feeding, ZDV therapy and elective CS are all implemented at a cost of 1968 UK pound per woman. From a public health perspective the ICER of ZDV and elective CS each depend on the acceptance rates of the other. In women counselled against breast-feeding, ZDV with 100% acceptance of elective CS has an ICER of 11 342 UK pound (95% confidence interval (CI), 7084-21 515 UK pound]. However, the ICER of CS ranges from 9248 UK pound (95% CI, 5072-46 913 pound sterling) at zero ZDV acceptance to 27 895 UK pound (95% CI, 10 018-154 462 pound sterling) at 100% ZDV acceptance.
Considering the estimated cost of caring for an infected child, ZDV appears to be cost-effective under any of the circumstances examined. However, elective CS may not be cost-effective in populations where the uptake of ZDV is high, and a more precise estimate of its efficacy is required.
评估降低母婴传播艾滋病毒风险的替代干预措施的成本效益。
使用一个模型来捕捉母婴传播在子宫内、分娩时和产后的连续性质，以确定人工喂养、选择性剖宫产（CS）和齐多夫定（ZDV）的效果如何结合以预防母婴艾滋病毒传播。参数估计来自文献，应用英国卫生服务成本，并估计替代风险降低策略的增量成本效益比（ICER）。结果可转换为其他成本假设或货币。
在一位母乳喂养婴儿、进行阴道分娩或急诊剖宫产且未服用ZDV的女性中，估计传播风险为31.6%（范围为23.7%-38.1%），每位女性的成本为400英镑；当同时实施人工喂养、ZDV治疗和选择性剖宫产时，传播风险降至3.7%（范围为1.7%-6.9%），每位女性的成本为1968英镑。从公共卫生角度来看，ZDV和选择性剖宫产的ICER均取决于对方的接受率。在接受反对母乳喂养咨询的女性中，ZDV在选择性剖宫产接受率为100%时的ICER为11342英镑（95%置信区间（CI），7084-21515英镑）。然而，剖宫产的ICER范围从ZDV接受率为零时的9248英镑（95%CI，5072-46913英镑）到ZDV接受率为100%时的27895英镑（95%CI，10018-154462英镑）。
考虑到照顾受感染儿童的估计成本，在任何所研究的情况下，ZDV似乎都具有成本效益。然而，在ZDV使用率高的人群中，选择性剖宫产可能不具有成本效益，需要对其疗效进行更精确的估计。
