Evaluating the cost-effectiveness of combination antiretroviral therapy for the prevention of mother-to-child transmission of HIV in Uganda
Andreas Kuznik, Mohammed Lamorde, Sabine Hermans, Barbara Castelnuovo, Brandon Auerbach, Aggrey Semeere, Joseph Sempa, Mark Ssennono, Fred Ssewankambo & Yukari C Manabe
Volume 90, Number 8, August 2012, 595-603
Table 1. Inputs used in the models to evaluate the cost-effectiveness of combination antiretroviral therapy (ART) in Uganda, 2011
| Input | Value |
|---|---|
| Cost inputs (US$ per patient) | |
| ART-related costs | |
| 6 weeks of nevirapine for neonatea | 11.23 |
| Annual costs | |
| Drugs for ARTb | 204.15 |
| Clinic personnelc | 42.96 |
| Laboratory investigationc | 35.04 |
| Other medicationc | 33.72 |
| Radiologyc | 1.68 |
| ART, total (excluding overhead and capital costs) | 328.77 |
| Overhead and capital costsd | 141.00 |
| Comparator regimens | |
| Single-dose nevirapinee | 0.06 |
| Dual therapy for 7 weeksf | 15.63 |
| Cost offsets | |
| Lifetime cost of ART for treated HIV-positive childg | 3808 |
| Lifetime cost of ART for untreated HIV-positive childh | 495 |
| Clinical inputs | |
| Transmission probability (%) | |
| ART | 3.8 |
| Dual therapy | 17.4 |
| Single-dose nevirapine | 25.8 |
| No treatment | 40.0 |
| Life expectancy at birth (years) | |
| Male | 52.17 |
| Female | 54.33 |
| HIV-positive neonate, treated | 14.23 |
| HIV-positive neonate, untreated | 2.00 |
| Disability weights | |
| HIV | 0.123 |
| AIDS | 0.505 |
| Fertility of HIV-positive women (children per woman) | 4.49 |
| Paediatric treatment rate (%) | 18 |
| Annual discount rate (%) | 3 |
AIDS, acquired immunodeficiency syndrome; HIV, human immunodeficiency virus; US$, United States dollar.
a The recommended 6-week course of nevirapine for the neonate, at 10 or 15 mg per day depending on birth weight, requires two or three 240-ml bottles of syrup containing 10 mg of nevirapine per ml. The assumption is that three bottles are required, each costing US$ 3.742.
b Although either nevirapine or efavirenz is recommended in combination with zidovudine and lamivudine, we modelled the per-patient cost of zidovudine, lamivudine and the relatively more expensive efavirenz, at US$ 16.04 per month. In addition, up to 20% of HIV-positive pregnant women may develop zidovudine-related anaemia.9 For such women, the zidovudine would have to be replaced with the more expensive tenofovir and this would increase the per-patient costs of ART to an estimated US$ 20.91 per month. The per-patient weighted mean drug cost for ART used in our analysis was therefore 80% of US$ 16.04 plus 20% of US$ 20.91 per month, which equals US$ 204.15 per year.
c Based on an analysis of the non-drug costs associated with ART that was conducted at a large urban outpatient HIV clinic in Kampala, Uganda, in which annual maintenance costs per patient were found to be approximately US$ 113.40 per year.8
d Only relevant in Models 2a and 2b. Based on Babigumira et al.8
e With 16 months of breastfeeding.10
f Based on the assumption that dual therapy with zidovudine and lamivudine is initiated in week 34 of the gestation and continued for 1 week after delivery. This results in a total of 7 weeks of therapy, at an estimated weekly cost of US$ 2.233 per patient.
g Discounted annual cost of ART of US$ 328.77 over 14.23 years.
h Based on Shah et al.11