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 5. Incremental costa per woman of Option B+b relative to Option Bc over 5 years postpartum, by CD4+ cell count and breastfeeding status, for varying rates of decline in CD4+ cell count

Breastfeeding status CD4+ count 350–500 cells/µl
CD4+ count > 500 cells/µl
Total cost Option B+ Total cost Option B Incremental cost Total cost Option B+ Total cost Option B Incremental cost
Breastfeeding (12 months)
Rate of CD4+ cell decline
    Averaged 2069 1814 255 2069 1261 808
    Rapide 2069 1948 121 2069 1261 808
    Slowf 1261 808 1261 808
ARV price
    Doubled 2905 2330 575 2905 1428 1477
    Halved 1650 1556 94 1650 1177 473
No breastfeeding
Rate of CD4+ cell decline
    Averaged 2069 1915 154 2069 1059 1010
    Rapidg 2069 1982 87 2069 1460 609
    Slowh 1730 339 1059 1010
ARV price
    Doubled 2905 2514 391 2905 1059 1846
    Halved 1650 1615 35 1650 1059 591

ARV, antiretroviral.

a All costs are given in 2011 United States dollars (US$).

b Option B+ comprises a triple antiretroviral (ARV) regimen initiated during pregnancy and continued for life.

c Option B comprises a maternal triple ARV regimen, typically consisting of the recommended first-line antiretroviral therapy, during pregnancy and throughout breastfeeding, in combination with 6 weeks of daily nevirapine for the infant, regardless of infant feeding method.

d 3.9 cells/µl/month.

e 4.9 cells/µl/month.

f 1.5 cells/µl/month.

g 6.0 cells/µl/month.

h 2.7 cells/µl/month.

Sources: CD4+ cell count declines for breastfeeding and non-breastfeeding women were obtained from Otieno;18 the full price of ARVs was obtained from WHO GPRM.17