Bulletin of the World Health Organization

The incremental cost of switching from Option B to Option B+ for the prevention of mother-to-child transmission of HIV

Lisa O’Brien, Nathan Shaffer, Nalinee Sangrujee & Taiwo O Abimbola

Volume 92, Number 3, March 2014, 162-170

Table 1. Model inputs – and their sources – for study of the incremental cost of switching from Option B to Option B+ for the prevention of mother-to-child transmission of HIV

Model input Value Source
Median postpartum CD4+ cell count, cells/µl
Lower: 350–500 425 Ekouevi, 201219
Higher: > 500 613 Ekouevi, 201219
CD4+ cell count for ART eligibility, cells/µl ≤ 350 WHO, 201022
Monthly decline in CD4+ cell count postpartum, cells/µl
Breastfeeding woman 3.2 (1.5, 4.9)a Otieno, 200718
Non-breastfeeding woman 4.4 (2.7, 6.0)a Otieno, 200718
Averageb 3.9 Estimated
Cost per patient per year, US$
ART
    TDF + 3TC + EFV 167.31 WHO, GPRM, 201117
Pre-ART period
    Co-trimoxazole, routine clinical monitoring and laboratory services 211.81 Menzies, 201116
First 12 months on ART
    Non-ARV drugs, routine clinical monitoring and laboratory services 378.54 Menzies, 201116
Maintained on ART
    Non-ARV drugs, routine clinical monitoring and laboratory services 246.42 Menzies, 201116

3TC, lamivudine; ART, antiretroviral therapy; ARV, antiretroviral; EFV, efavirenz; TDF, tenofovir; US$, United States dollars; WHO, World Health Organization.

a Values in parentheses were used to simulate a slow and a rapid monthly decline in CD4+ cell count.

b Breastfeeding and non-breastfeeding women.