Cost-effectiveness of short-course zidovudine to prevent perinatal HIV type 1 infection in a sub-Saharan African Developing country setting
G. Mansergh, A. C. Haddix, R. W. Steketee, P. I. Nieburg, D. J. Hu, R. J. Simonds and M. Rogers
Epidemiology Branch, NCHSTP, MSE-45, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
OBJECTIVE--To evaluate the cost-effectiveness of a short-course zidovudine
program to prevent perinatal transmission of human immunodeficiency virus
(HIV) type 1 in sub-Saharan African country settings. DESIGN AND
SETTING--Several clinical trials of short-course zidovudine during
pregnancy for prevention of perinatal transmission of HIV are under way in
developing countries in sub-Saharan Africa. A decision model was used to
examine the cost-effectiveness of zidovudine programs in a hypothetical
1-year birth cohort in a sub-Saharan African setting from the perspective
of the health care system and of society. A completed short course of
zidovudine was assumed to reduce perinatal HIV transmission from 25% to
16.5%, approximately one half of the effect of the longer-course
zidovudine. Estimates of program costs, lifetime HIV-related health care
costs, and lost productivity costs were derived from the published
literature and from preliminary data available from sites of planned
clinical trials. Sensitivity analyses were conducted on all relevant
parameters. MAIN OUTCOME MEASURES--Medical costs, lost productivity costs,
program costs, cost savings, and incremental cost-effectiveness, expressed
as cost per infant HIV infection prevented. RESULTS--The model estimated
that a national zidovudine program in a setting with 12.5% HIV
seroprevalence would reduce perinatal HIV incidence by 12% (4.9 infections
per 1000 births). The costs to the health care system would be $3748 per
infant HIV infection prevented. When productivity losses were included in
the model, the cost decreases to $1115 per infant HIV infection prevented.
The cost to implement a national zidovudine program including the cost of
counseling, testing, and drugs, would be $2 million per 100,000 births or
$20 per pregnant woman. In the base case, decreases in the cost of
counseling and testing and increases in maternal HIV prevalence, zidovudine
efficacy, and medical and lost productivity costs improved
cost-effectiveness of the zidovudine program. CONCLUSIONS--Assuming
demonstrable efficacy of short-course zidovudine prevention of perinatal
HIV, a national perinatal HIV prevention program with zidovudine in most
sub-Saharan African country settings would reduce the incidence of infant
HIV infection and, in some settings, provide societal savings; however,
substantial initial investment in such programs will be required. Where
health care resources are limited, as in these regions, allocation of
resources to a perinatal zidovudine program will need to be considered in
the context of resources required for other pressing medical care needs.
