Cost effectiveness of a single-dose nevirapine regimen for mothers and babies to decrease vertical HIV-1 transmission in sub-Saharan Africa

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Cost effectiveness of a single-dose nevirapine
regimen for mothers and babies to decrease
vertical HIV-1 transmission in sub-Saharan
Africa

• Rumalda Paniagua

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Rationale

• To identify cost-effective interventions to
  decrease transmission of HIV-1 from the mother to
  child

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Statistics of HIV-1 infected children in Africa

• In 1997, 600,000 children infected with HIV-1,
  about 1,600 children daily
• 3 million children have been infected since the
  beginning of the epidemic and 90 of these were
  born in Africa
• Annual incidence of childhood HIV-1 is 530,000
  children

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Current Antiretroviral Treatments

• AIDS Clinical Trials Group (ACTG) protocol 076
• PETRA regimen
• Thai regimen
• HIVNET 012 regimen

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AIDS Clinical Trials Group (ACTG) protocol 076
Zidovudine Treatment

• Administered early in pregnancy, during delivery
  and to babies for the first 6 weeks of life
• HIV-1 transmission decreased by two-thirds in
  more developed countries
• Course of treatment is too long
• Cost is US200 per mother-baby pair for drugs
  alone
• Treatment with zidovudine not as cost-effective

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PETRA RegimensPETRA-A

• Intrapartum
• 51 efficiency
• Twice daily from 38 weeks gestation until
  delivery
• 300 mg zidovudine every 3 hr during labour
• 150 mg lamivudine every 3 hr during labour

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PETRA RegimensPETRA-B

• Postpartum
• 37 efficiency
• Babys dosage
• Zidovudine 5 mg/kg every 12 hrs for 1 week
• Lamivudine 2 mg/kg every 12 hrs for 1 week

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Thai Regimen

• 50 efficacy
• Starts at 36 weeks gestation
• 300 mg zidovudine twice daily, every 3 hr during
  labour until delivery

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HIVNET 012 Regimen

• Nevirapine 200 mg oral dose to mothers at onset
  of labour and 2 mg/kg to babies within 72 hrs of
  birth

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Definitions

• Disability-adjusted life-year (DALY)
• Sum of the years of life saved
• Weighted to reflect quality of life
• Socioeconomic value of each life-year
• HIV-1 Seroprevalence
• The incidence of HIV-1 in the serum
• Measured at 15 and 30

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Outcome measures of the study

• Program cost
• Number of HIV-1 cases prevented in children
• Cost per case prevented
• Cost per disability-adjusted life-year (DALY)

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Implementation Strategies of the Study

• Targeted Treatment
• Nevirapine drug
• Provided counseling and HIV-1 testing before
  treatment
• Universal Treatment
• Nevirapine for all pregnant women
• No counseling
• No testing

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Study Model

• Hypothetical cohort of 20,000 pregnant women in
  sub-Saharan Africa
• Conducted analysis from public-sector health-care
  payer point of view
• Payer pays all costs for testing, counseling and
  treatment

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Study Model (continued)

• Comparison of HIVNET 012 to PETRA and Thai
  regimens

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Results HIVNET 012 Universal vs. Targeted
Treatment (Table 2)

• Program cost per 20,000 women
• HIV-1 cases prevented
• DALYs saved
• Cost per HIV-1 case prevented (US)
• Cost per DALY (US)

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Results (continued)

• Net program costs (US)
• PETRA-A 876,879
• PETRA-B 289,444
• Thai 340,892
• HIVNET Universal83,333
• HIVNET Targeted 141,922

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Conclusion

• HIVNET Universal most cost-effective treatment
• Studies show very promising results
• Extremely important to find a cost-efficient
  treatment
• Article should explain mechanism of prevention of
  transmission

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