Cost-effectiveness of nevirapine to prevent mother-to-child HIV transmission in eight African countries
Cost-effectiveness of nevirapine to prevent mother-to-child HIV transmission in eight African countries
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DOI：
10.1097/01.aids.0000131353.06784.8f
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发表时间：
2004-08-20
期刊：
影响因子：
3.8
通讯作者：
de Zoysa, I
中科院分区：
文献类型：
--
作者：
Sweat, MD;O'Reilly, KR;de Zoysa, I
背景：建议采取综合办法预防婴儿感染艾滋病毒，包括：(A)预防年轻妇女感染艾滋病毒，(b)减少感染艾滋病毒的妇女意外怀孕，(c)预防垂直传播，以及(d)向感染艾滋病毒的妇女及其家人提供护理、治疗和支助。基于奈韦拉平价格低廉且具有成本效益的分析，大多数注意力都放在了防止垂直传播上。方法：使用来自八个非洲国家的数据确定以下内容：国家规划成本和对婴儿感染的影响；降低成人艾滋病毒感染率和艾滋病毒感染妇女的意外怀孕，这将对奈韦拉平干预措施避免的婴儿艾滋病毒感染产生同等影响；以及比奈韦拉平更有效的药物的成本门槛，每节省的DALY成本相当。结果：全国每年平均项目费用为480万美元。每个国家平均避免了1898例婴儿艾滋病毒感染（每例艾滋病毒感染2517美元，每例DALY避免84美元）。将妇女的艾滋病毒流行率降低1.25%或将感染艾滋病毒的妇女的意外怀孕率降低16%，婴儿病例也会相应减少。一种疗效为70%的抗逆转录病毒药物可能要花费152美元，其每避免的活年成本与疗效为47%的奈韦拉平相同。结论：奈韦拉平预防的成本-效果受卫生系统成本、客户使用率低和奈韦拉平疗效差的影响。产妇艾滋病毒流行率或感染艾滋病毒的妇女意外怀孕的小幅减少对婴儿艾滋病毒发病率也有同样的影响，应成为减少婴儿感染人数的总体战略的一部分。(C) 2004利平科特·威廉姆斯·威尔金斯。
Background: A comprehensive approach to preventing HIV infection in infants has been recommended, including: (a) preventing HIV in young women, (b) reducing unintended pregnancies among HIV-infected women, (c) preventing vertical transmission (PMTCT), and (d) providing care, treatment, and support to HIV-infected women and their families. Most attention has been given to preventing vertical transmission based on analysis showing nevirapine to be inexpensive and cost-effective.Methods: The following were determined using data from eight African countries: national program costs and impact on infant infections; reductions in adult HIV prevalence and unintended pregnancies among HIV-infected women that would have equivalent impact on infant HIV infections averted as the nevirapine intervention; and the cost threshold for drugs with greater efficacy than nevirapine yielding an equivalent cost per DALY saved.Results: Average national annual program cost was $4.8 million. There was, per country, an average of 1898 averted infant HIV infections (US$2517 per HIV infection and US$84 per DALY averted). Lowering HIV prevalence among women by 1.25% or reducing unintended pregnancy among HIV-infected women by 16% yielded an equivalent reduction in infant cases. An antiretroviral drug with 70% efficacy could cost US$152 and have the same cost per DALY averted as nevirapine at 47% efficacy.Conclusions: Cost-effectiveness of nevirapine prophylaxis is influenced by health system costs, low client uptake, and poor effectiveness of nevirapine. Small reductions in maternal HIV prevalence or unintended pregnancy by HIV-infected women have equivalent impacts on infant HIV incidence and should be part of an overall strategy to lessen numbers of infant infections. (C) 2004 Lippincott Williams Wilkins.