Cost-Effectiveness Analysis of Option B+ for HIV Prevention and Treatment of Mothers and Children in Malawi
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{"title"=>"Cost-Effectiveness Analysis of Option B+ for HIV Prevention and Treatment of Mothers and Children in Malawi", "type"=>"journal", "authors"=>[{"first_name"=>"Olufunke", "last_name"=>"Fasawe", "scopus_author_id"=>"55621005900"}, {"first_name"=>"Carlos", "last_name"=>"Avila", "scopus_author_id"=>"7101629566"}, {"first_name"=>"Nathan", "last_name"=>"Shaffer", "scopus_author_id"=>"7006659834"}, {"first_name"=>"Erik", "last_name"=>"Schouten", "scopus_author_id"=>"8935125600"}, {"first_name"=>"Frank", "last_name"=>"Chimbwandira", "scopus_author_id"=>"36489137600"}, {"first_name"=>"David", "last_name"=>"Hoos", "scopus_author_id"=>"6507119418"}, {"first_name"=>"Olive", "last_name"=>"Nakakeeto", "scopus_author_id"=>"26646831100"}, {"first_name"=>"Paul", "last_name"=>"de Lay", "scopus_author_id"=>"6506711775"}], "year"=>2013, "source"=>"PLoS ONE", "identifiers"=>{"pmid"=>"23554867", "doi"=>"10.1371/journal.pone.0057778", "sgr"=>"84874864115", "isbn"=>"1932-6203 (Electronic)\\r1932-6203 (Linking)", "scopus"=>"2-s2.0-84874864115", "issn"=>"19326203", "pui"=>"368517992"}, "id"=>"918e8c7a-a5c7-3a43-bd6f-f237e4978402", "abstract"=>"BACKGROUND: The Ministry of Health in Malawi is implementing a pragmatic and innovative approach for the management of all HIV-infected pregnant women, termed Option B+, which consists of providing life-long antiretroviral treatment, regardless of their CD4 count or clinical stage. Our objective was to determine if Option B+ represents a cost-effective option.\\n\\nMETHODS: A decision model simulates the disease progression of a cohort of HIV-infected pregnant women receiving prophylaxis and antiretroviral therapy, and estimates the number of paediatric infections averted and maternal life years gained over a ten-year time horizon. We assess the cost-effectiveness from the Ministry of Health perspective while taking into account the practical realities of implementing ART services in Malawi.\\n\\nRESULTS: If implemented as recommended by the World Health Organization, options A, B and B+ are equivalent in preventing new infant infections, yielding cost effectiveness ratios between US$ 37 and US$ 69 per disability adjusted life year averted in children. However, when the three options are compared to the current practice, the provision of antiretroviral therapy to all mothers (Option B+) not only prevents infant infections, but also improves the ten-year survival in mothers more than four-fold. This translates into saving more than 250,000 maternal life years, as compared to mothers receiving only Option A or B, with savings of 153,000 and 172,000 life years respectively. Option B+ also yields favourable incremental cost effectiveness ratios (ICER) of US$ 455 per life year gained over the current practice.\\n\\nCONCLUSION: In Malawi, Option B+ represents a favorable policy option from a cost-effectiveness perspective to prevent future infant infections, save mothers' lives and reduce orphanhood. Although Option B+ would require more financial resources initially, it would save societal resources in the long-term and represents a strategic option to simplify and integrate HIV services into maternal, newborn and child health programmes.", "link"=>"http://www.mendeley.com/research/costeffectiveness-analysis-option-b-hiv-prevention-treatment-mothers-children-malawi-1", "reader_count"=>108, "reader_count_by_academic_status"=>{"Professor > Associate Professor"=>4, "Student > Doctoral Student"=>6, "Researcher"=>15, "Student > Ph. D. Student"=>14, "Student > Postgraduate"=>9, "Student > Master"=>39, "Other"=>7, "Student > Bachelor"=>7, "Lecturer"=>2, "Lecturer > Senior Lecturer"=>2, "Professor"=>3}, "reader_count_by_user_role"=>{"Professor > Associate Professor"=>4, "Student > Doctoral Student"=>6, "Researcher"=>15, "Student > Ph. D. Student"=>14, "Student > Postgraduate"=>9, "Student > Master"=>39, "Other"=>7, "Student > Bachelor"=>7, "Lecturer"=>2, "Lecturer > Senior Lecturer"=>2, "Professor"=>3}, "reader_count_by_subject_area"=>{"Unspecified"=>3, "Agricultural and Biological Sciences"=>9, "Arts and Humanities"=>1, "Business, Management and Accounting"=>6, "Computer Science"=>1, "Economics, Econometrics and Finance"=>5, "Environmental Science"=>1, "Nursing and Health Professions"=>10, "Biochemistry, Genetics and Molecular Biology"=>1, "Mathematics"=>2, "Medicine and Dentistry"=>48, "Psychology"=>3, "Social Sciences"=>16, "Immunology and Microbiology"=>2}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>48}, "Social Sciences"=>{"Social Sciences"=>16}, "Psychology"=>{"Psychology"=>3}, "Mathematics"=>{"Mathematics"=>2}, "Unspecified"=>{"Unspecified"=>3}, "Environmental Science"=>{"Environmental Science"=>1}, "Arts and Humanities"=>{"Arts and Humanities"=>1}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>5}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>2}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>9}, "Computer Science"=>{"Computer Science"=>1}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>6}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>10}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>1}}, "reader_count_by_country"=>{"Canada"=>1, "Mozambique"=>1, "United States"=>1, "Tanzania"=>1, "South Africa"=>1, "Kenya"=>2, "Switzerland"=>2, "Spain"=>2}, "group_count"=>11}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/985367"], "description"=>"<p>Tornado diagram for the ICER of Option B+, base case is $455 per life year gained shown with the dotted line.</p>", "links"=>[], "tags"=>["diagram", "icer", "gained", "dotted"], "article_id"=>650722, "categories"=>["Cancer", "Science Policy", "Mathematics", "Infectious Diseases", "Biotechnology", "Medicine"], "users"=>["Olufunke Fasawe", "Carlos Avila", "Nathan Shaffer", "Erik Schouten", "Frank Chimbwandira", "David Hoos", "Olive Nakakeeto", "Paul De Lay"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0057778.g003", "stats"=>{"downloads"=>1, "page_views"=>23, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Tornado_diagram_for_the_ICER_of_Option_B_base_case_is_455_per_life_year_gained_shown_with_the_dotted_line_/650722", "title"=>"Tornado diagram for the ICER of Option B+, base case is $455 per life year gained shown with the dotted line.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-03-13 09:56:41"}
  • {"files"=>["https://ndownloader.figshare.com/files/1012275"], "description"=>"<p><b>Table 1.</b> ARV regimens for HIV prevention and treatment of mothers and children compared in the analysis - Current Practice 2010, WHO Option A, WHO Option B and Malawi's Option B+.</p>", "links"=>[], "tags"=>["arv", "regimens", "hiv", "mothers", "children", "compared"], "article_id"=>672681, "categories"=>["Cancer", "Science Policy", "Mathematics", "Infectious Diseases", "Biotechnology", "Medicine"], "users"=>["Olufunke Fasawe", "Carlos Avila", "Nathan Shaffer", "Erik Schouten", "Frank Chimbwandira", "David Hoos", "Olive Nakakeeto", "Paul De Lay"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0057778.t005", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Table_1_ARV_regimens_for_HIV_prevention_and_treatment_of_mothers_and_children_compared_in_the_analysis_Current_Practice_2010_WHO_Option_A_WHO_Option_B_and_Malawi_s_Option_B_/672681", "title"=>"<b>Table 1.</b> ARV regimens for HIV prevention and treatment of mothers and children compared in the analysis - Current Practice 2010, WHO Option A, WHO Option B and Malawi's Option B+.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-03-12 00:44:41"}
  • {"files"=>["https://ndownloader.figshare.com/files/1012303"], "description"=>"*<p>Assumes 663,000 pregnant women, 66,500 HIV-infected pregnant women annually, and 90% (59,850) of those women reached by Option A, B and B+.</p>**<p>Assumes no needed CD4 to start ART under the Malawi Option B+ approach; however, in practice some HIV-infected pregnant women will have access to CD4 testing as part of staging and response to treatment</p>***<p>Background infections if no ARV interventions = 20,681</p>", "links"=>[], "tags"=>["paediatric", "outcomes", "preventing", "programmatic", "interventions", "18", "months", "prophylaxis"], "article_id"=>672706, "categories"=>["Cancer", "Science Policy", "Mathematics", "Infectious Diseases", "Biotechnology", "Medicine"], "users"=>["Olufunke Fasawe", "Carlos Avila", "Nathan Shaffer", "Erik Schouten", "Frank Chimbwandira", "David Hoos", "Olive Nakakeeto", "Paul De Lay"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0057778.t002", "stats"=>{"downloads"=>1, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Costs_and_paediatric_outcomes_from_preventing_mother_to_child_transmission_programmatic_interventions_for_18_months_of_prophylaxis_and_treatment_US_2010_/672706", "title"=>"Costs and paediatric outcomes from preventing mother to child transmission programmatic interventions for 18 months of prophylaxis and treatment<sup>*</sup> (US $ 2010).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-03-12 00:45:06"}
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Relative Metric

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