Prevention of mother-to-child transmission of HIV-1 infection : alternative strategies and their cost-effectiveness.
To estimate the cost-effectiveness of alternative interventions to reduce the risk of mother-to-child transmission of HIV.
A model capturing the sequential nature of mother-to-child transmission in utero, at delivery and postnatally was used to determine how the effects of bottle-feeding, elective Cesarean section (CS) and zidovudine (ZDV) would combine to prevent mother-to-child HIV transmission.
Parameter estimates were derived from the literature, UK health service costs applied, and incremental cost effectiveness ratios (ICER) estimated for alternative risk reduction strategies.
Results can be transposed to other cost assumptions or currencies.
In a woman who breast-feeds her baby, has a vaginal or emergency CS delivery and takes no ZDV, the estimated transmission risk is 31.6% (range, 23.7-38.1%), at a cost of UK£400 per woman ; this falls to a risk of 3.7% (range, 1.7-6.9%) when bottle-feeding, ZDV therapy and elective CS are all implemented at a cost of UK£1968 per woman.
From a public health perspective the ICER of ZDV and elective CS each depend on the acceptance rates of the other.
In women counselled against breast-feeding, ZDV with 100% acceptance of elective CS has an ICER of UK£11 342 195% confidence interval (Cl), UK£7084-21 515]. However, the ICER of CS ranges from UK£9248 (95% Cl, £5072-46 913) at zero ZDV acceptance to UK£27 895 (95% Cl, £10 018-154 462) at 100% ZDV acceptance. (...)
Mots-clés Pascal : SIDA, Virose, Infection, Transmission mère enfant, Gestation, Périnatal, Prévention, Méthode, Analyse coût efficacité, Coût, Enfant, Homme, Virus HIV1, Virus immunodéficience humaine, Lentivirus, Retroviridae, Virus, Césarienne, Antiviral, Chimiothérapie, Modélisation, Risque, Immunopathologie, Immunodéficit, Mère pathologie, Economie santé, Chirurgie
Mots-clés Pascal anglais : AIDS, Viral disease, Infection, Mother to child transmission, Pregnancy, Perinatal, Prevention, Method, Cost efficiency analysis, Costs, Child, Human, HIV-1 virus, Human immunodeficiency virus, Lentivirus, Retroviridae, Virus, Cesarean section, Antiviral, Chemotherapy, Modeling, Risk, Immunopathology, Immune deficiency, Maternal diseases, Health economy, Surgery
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0393429
Code Inist : 002B05C02D. Création : 25/01/1999.