Cost-effectiveness analysis of Option B+ for HIV prevention and treatment of mothers and children in Malawi

PLoS One. 2013;8(3):e57778. doi: 10.1371/journal.pone.0057778. Epub 2013 Mar 12.

Abstract

Background: The Ministry of Health in Malawi is implementing a pragmatic and innovative approach for the management of all HIV-infected pregnant women, termed Option B+, which consists of providing life-long antiretroviral treatment, regardless of their CD4 count or clinical stage. Our objective was to determine if Option B+ represents a cost-effective option.

Methods: A decision model simulates the disease progression of a cohort of HIV-infected pregnant women receiving prophylaxis and antiretroviral therapy, and estimates the number of paediatric infections averted and maternal life years gained over a ten-year time horizon. We assess the cost-effectiveness from the Ministry of Health perspective while taking into account the practical realities of implementing ART services in Malawi.

Results: If implemented as recommended by the World Health Organization, options A, B and B+ are equivalent in preventing new infant infections, yielding cost effectiveness ratios between US$ 37 and US$ 69 per disability adjusted life year averted in children. However, when the three options are compared to the current practice, the provision of antiretroviral therapy to all mothers (Option B+) not only prevents infant infections, but also improves the ten-year survival in mothers more than four-fold. This translates into saving more than 250,000 maternal life years, as compared to mothers receiving only Option A or B, with savings of 153,000 and 172,000 life years respectively. Option B+ also yields favourable incremental cost effectiveness ratios (ICER) of US$ 455 per life year gained over the current practice.

Conclusion: In Malawi, Option B+ represents a favorable policy option from a cost-effectiveness perspective to prevent future infant infections, save mothers' lives and reduce orphanhood. Although Option B+ would require more financial resources initially, it would save societal resources in the long-term and represents a strategic option to simplify and integrate HIV services into maternal, newborn and child health programmes.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Antiviral Agents* / administration & dosage
  • Antiviral Agents* / economics
  • Child
  • Child, Preschool
  • Costs and Cost Analysis
  • Female
  • HIV Infections / economics
  • HIV Infections / epidemiology
  • HIV Infections / prevention & control
  • Humans
  • Infant
  • Infant, Newborn
  • Malawi / epidemiology
  • Male
  • Pregnancy
  • Pregnancy Complications, Infectious* / economics
  • Pregnancy Complications, Infectious* / epidemiology
  • Pregnancy Complications, Infectious* / prevention & control
  • World Health Organization

Substances

  • Antiviral Agents

Grant support

The authors have no support or funding to report.