Monitoring and costs
Q.37 What would be the cost of implementing the 2010 HIV and infant feeding recommendations?
In 2009, the cost of providing appropriate ARVs for 10,000 women or their infants with breastfeeding up to 12 months was estimated to be approximately US$ 1 million, or about US$ 100 per woman per year. Under a similar scenario, but with formula feeding instead of breastfeeding as the national option, the cost would be at least double. These figures reflect only the costs of the respective commodities including distribution and storage, and not the costs of other human resource or health systems requirements or supplies.
This rough calculation illustrates the significantly higher cost of providing formula milk as a strategy for PMTCT. It does not reflect the costs of treating diarrhoea or malnutrition that might be associated with non-breastfeeding, and any increased household expense.
In considering which infant feeding practice to recommend, either breastfeeding and ARVs or avoidance of all breastfeeding, national authorities should first consider the health benefits and then the financial cost of each approach. Mathematical modelling suggests that in countries where diarrhoea, pneumonia or malnutrition are significant causes of infant and child mortality, breastfeeding HIV-exposed infants for 12 months while giving mothers or infants the recommended ARVs will give infants the greatest chance of survival while remaining HIV uninfected. If a national authority determines to recommend this approach, then the savings of not providing infant formula can be used to improve the coverage and quality of PMTCT interventions and to invest in improved infant and young child feeding support for the entire population.