Wilkinson D, Floyd K, Gilks C F
Centre for Epidemiological Research in Southern Africa, Medical Research Council, Mtubatuba.
AIDS. 1998 Sep 10;12(13):1675-82. doi: 10.1097/00002030-199813000-00016.
To estimate cost-effectiveness and capacity requirements for providing antiretroviral drugs to pregnant HIV-infected women in rural South Africa.
Hlabisa health district, where HIV prevalence among pregnant women was 26.0% in 1997.
Calculation of the number of paediatric HIV infections averted under three scenarios, and their cost. No intervention was compared with scenario A (zidovudine delivered within current infrastructure), scenario B (zidovudine delivered through enhanced infrastructure), and scenario C (short-course zidovudine plus lamivudine delivered through enhanced infrastructure). Cost-effectiveness was defined as cost per infection averted and cost per potential life-year gained. Capacity was determined in terms of staff and infrastructure required to effectively implement the scenarios.
With no intervention, 657 paediatric HIV infections were projected for 1997. In scenario A this could be reduced by 15% at a cost of US$ 574 825, in scenario B by 42% at US$ 1520770, and in scenario C by 47% at US$ 764901. In scenario C, drugs accounted for 76% of costs, whereas additional staff accounted for 18%. Cost per infection averted was US$ 2492 and cost per potential life-year gained (discounted at 3%) was US$ 88. Cost of scenario C was equivalent to 14% of the 1997 district health budget. At least 12 extra counsellors and nurses and one laboratory technician, together with substantial logistical and managerial support, would be needed to deliver an effective intervention.
Although antiretrovirals may be relatively cost-effective in this setting, the budget required is currently unaffordable. Developing the capacity required to deliver the intervention would pose both a major challenge, and an opportunity, to improve health services.
评估在南非农村地区为感染艾滋病毒的孕妇提供抗逆转录病毒药物的成本效益和能力需求。
赫拉比萨卫生区，1997年孕妇中的艾滋病毒流行率为26.0%。
计算在三种情况下避免的儿童艾滋病毒感染数量及其成本。将不进行干预的情况与方案A（在现有基础设施内提供齐多夫定）、方案B（通过加强基础设施提供齐多夫定）和方案C（通过加强基础设施提供短疗程齐多夫定加拉米夫定）进行比较。成本效益定义为避免每例感染的成本和每获得一个潜在生命年的成本。根据有效实施这些方案所需的人员和基础设施来确定能力。
若不进行干预，预计1997年有657例儿童感染艾滋病毒。在方案A中，可减少15%，成本为574,825美元；在方案B中，可减少42%，成本为1,520,770美元；在方案C中，可减少47%，成本为764,901美元。在方案C中，药物占成本的76%，而额外的工作人员占18%。避免每例感染的成本为2492美元，每获得一个潜在生命年（按3%贴现）的成本为88美元。方案C的成本相当于1997年该地区卫生预算的14%。要实施有效的干预措施，至少需要额外增加12名咨询员和护士以及1名实验室技术员，同时还需要大量的后勤和管理支持。
尽管在这种情况下抗逆转录病毒药物可能具有相对成本效益，但目前所需的预算难以承受。发展实施干预措施所需的能力将对改善卫生服务构成重大挑战，同时也是一个机遇。
