Cost effectiveness of single-dose nevirapine regimen for mothers and babies to decrease vertical HIV-1 transmission in sub-Saharan Africa
Cost effectiveness of single-dose nevirapine regimen for mothers and babies to decrease vertical HIV-1 transmission in sub-Saharan Africa
复制标题
DOI：
10.1016/s0140-6736(99)80009-9
复制
发表时间：
1999-09-04
期刊：
影响因子：
168.9
通讯作者：
Jackson, JB
中科院分区：
文献类型：
--
作者：
Marseille, E;Kahn, JG;Jackson, JB
在撒哈拉以南非洲地区，确定经济干预措施以减少HIV-1向儿童的传播是一项紧迫的公共卫生优先事项。我们评估的HIVNET 012 nevirapine regiment.Methods的成本效益，我们评估了在撒哈拉以南非洲的20 000名孕妇在一个假设的队列的成本效益。我们的主要结果指标是项目成本、避免的儿科HIV-1病例、避免的每例病例成本和每残疾调整生命年（DALY）成本。我们将HIVNET 012与其他短期抗逆转录病毒治疗方案进行了比较。我们还比较了两种实施策略：治疗前咨询和HIV-1检测（有针对性的治疗），或所有孕妇的奈韦拉平（普遍治疗，无咨询和检测）。我们做了单变量和多变量的敏感性analysis.Findings为普及治疗与30%的HIV-1血清阳性率，HIVNET 012方案将避免603例HIV-1的婴儿，成本为83 333美元，并产生15 862 DALYS。相关的成本效益比为每避免一个病例138美元或每残疾调整生命年5.25美元。在15%的血清阳性率下，普遍治疗方案将花费83 333美元，避免302例，每例避免276美元或每DALY 10.51美元。对于30%血清阳性率的靶向治疗，HIVNET 012将花费141 922美元，避免476例病例，每例避免298美元或每DALY 11.29美元。由于普遍治疗的血清阳性率高于3.0%，靶向治疗的血清阳性率高于4.5%，HIVNET 012方案可能与其他公共卫生干预措施一样具有成本效益。在敏感性分析中，HIVNET 012的成本效益在广泛的参数范围内是稳健的。解释HIVNET 012方案在高血清阳性率环境中具有高度的成本效益。在血清阳性率较低的地区，当多剂量方案不具有成本效益时，奈韦拉平治疗可能以合理的成本产生重大的公共卫生影响。
Background Identification of economical interventions to decrease HIV-1 transmission to children is an urgent public-health priority in sub-Saharan Africa. We assessed the cost effectiveness of the HIVNET 012 nevirapine regimen.Methods We assessed cost effectiveness in a hypothetical cohort of 20 000 pregnant women in sub-Saharan Africa. Our main outcome measures were programme cost, paediatric HIV-1 cases averted, cost per case averted, and cost per disability-adjusted life-year (DALY). We compared HIVNET 012 with other short-course antiretroviral regimens. We also compared two implementation strategies: counselling and HIV-1 testing before treatment (targeted treatment), or nevirapine for all pregnant women (universal treatment, no counselling and testing). We did univariate and multivariate sensitivity analyses.Findings For universal treatment with 30% HIV-1 seroprevalence, the HIVNET 012 regimen would avert 603 cases of HIV-1 in babies, cost US$83 333, and generate 15 862 DALYs. The associated cost-effectiveness ratios were $138 per case averted or $5.25 per DALY. At 15% seroprevalence, the universal treatment option would cost $83 333 and avert 302 cases at $276 per case averted or $10.51 per DALY. For targeted treatment at 30% seroprevalence, HIVNET 012 would cost $141 922 and avert 476 cases at $298 per case averted or $11.29 per DALY. With seroprevalence higher than 3.0% for universal and 4.5% for targeted treatment, the HIVNET 012 regimen was likely to be as cost effective as other public-health interventions. The cost effectiveness of HIVNET 012 was robust under a wide range of parameters in the sensitivity analysis.Interpretation The HIVNET 012 regimen can be highly cost-effective in high seroprevalence settings. In lower seroprevalence areas, when multidose regimens are not cost effective, nevirapine therapy could have a major public-health impact at a reasonable cost.