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Cost-effectiveness of option B+ in prevention of mother-to-child transmission of HIV in Yunnan Province, China

BACKGROUND: Although Option B+ may be more costly than Options B, it may provide additional health benefits that are currently unclear in Yunnan province. We created deterministic models to estimate the cost-effectiveness of Option B+. METHODS: Data were used in two deterministic models simulating a...

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Autores principales: Wang, Xiaowen, Guo, Guangping, Zheng, Jiarui, Lu, Lin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560771/
https://www.ncbi.nlm.nih.gov/pubmed/31185927
http://dx.doi.org/10.1186/s12879-019-3976-5
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author Wang, Xiaowen
Guo, Guangping
Zheng, Jiarui
Lu, Lin
author_facet Wang, Xiaowen
Guo, Guangping
Zheng, Jiarui
Lu, Lin
author_sort Wang, Xiaowen
collection PubMed
description BACKGROUND: Although Option B+ may be more costly than Options B, it may provide additional health benefits that are currently unclear in Yunnan province. We created deterministic models to estimate the cost-effectiveness of Option B+. METHODS: Data were used in two deterministic models simulating a cohort of 2000 HIV+ pregnant women. A decision tree model simulated the number of averted infants infections and QALY acquired for infants in the PMTCT period for Options B and B+. The minimum cost was calculated. A Markov decision model simulated the number of maternal life year gained and serodiscordant partner infections averted in the ten years after PMTCT for Option B or B+. ICER per life year gained was calculated. Deterministic sensitivity analyses were conducted. RESULTS: If fully implemented, Option B and Option B+ averted 1016.85 infections and acquired 588,01.02 QALYs.The cost of Option B was US$1,229,338.47, the cost of Option B+ was 1,176,128.63. However, when Options B and B+ were compared over ten years, Option B+ not only improved mothers’ten-year survival from 69.7 to 89.2%, saving more than 3890 life-years, but also averted 3068 HIV infections between serodiscordant partners. Option B+ yielded a favourable ICER of $32.99per QALY acquired in infants and $5149per life year gained in mothers. A 1% MTCT rate, a 90% coverage rate and a 20-year horizon could decrease the ICER per QALY acquired in children and LY gained in mothers. CONCLUSIONS: Option B+ is a cost-effective treatment for comprehensive HIV prevention for infants and serodiscordant partners and life-long treatment for mothers in Yunnan province, China. Option B+ could be implemented in Yunnan province, especially as the goals of elimination mother-to-child transmission of HIV and “90–90-90” achieved, Option B+ would be more attractive. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12879-019-3976-5) contains supplementary material, which is available to authorized users.
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spelling pubmed-65607712019-06-14 Cost-effectiveness of option B+ in prevention of mother-to-child transmission of HIV in Yunnan Province, China Wang, Xiaowen Guo, Guangping Zheng, Jiarui Lu, Lin BMC Infect Dis Research Article BACKGROUND: Although Option B+ may be more costly than Options B, it may provide additional health benefits that are currently unclear in Yunnan province. We created deterministic models to estimate the cost-effectiveness of Option B+. METHODS: Data were used in two deterministic models simulating a cohort of 2000 HIV+ pregnant women. A decision tree model simulated the number of averted infants infections and QALY acquired for infants in the PMTCT period for Options B and B+. The minimum cost was calculated. A Markov decision model simulated the number of maternal life year gained and serodiscordant partner infections averted in the ten years after PMTCT for Option B or B+. ICER per life year gained was calculated. Deterministic sensitivity analyses were conducted. RESULTS: If fully implemented, Option B and Option B+ averted 1016.85 infections and acquired 588,01.02 QALYs.The cost of Option B was US$1,229,338.47, the cost of Option B+ was 1,176,128.63. However, when Options B and B+ were compared over ten years, Option B+ not only improved mothers’ten-year survival from 69.7 to 89.2%, saving more than 3890 life-years, but also averted 3068 HIV infections between serodiscordant partners. Option B+ yielded a favourable ICER of $32.99per QALY acquired in infants and $5149per life year gained in mothers. A 1% MTCT rate, a 90% coverage rate and a 20-year horizon could decrease the ICER per QALY acquired in children and LY gained in mothers. CONCLUSIONS: Option B+ is a cost-effective treatment for comprehensive HIV prevention for infants and serodiscordant partners and life-long treatment for mothers in Yunnan province, China. Option B+ could be implemented in Yunnan province, especially as the goals of elimination mother-to-child transmission of HIV and “90–90-90” achieved, Option B+ would be more attractive. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12879-019-3976-5) contains supplementary material, which is available to authorized users. BioMed Central 2019-06-11 /pmc/articles/PMC6560771/ /pubmed/31185927 http://dx.doi.org/10.1186/s12879-019-3976-5 Text en © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Wang, Xiaowen
Guo, Guangping
Zheng, Jiarui
Lu, Lin
Cost-effectiveness of option B+ in prevention of mother-to-child transmission of HIV in Yunnan Province, China
title Cost-effectiveness of option B+ in prevention of mother-to-child transmission of HIV in Yunnan Province, China
title_full Cost-effectiveness of option B+ in prevention of mother-to-child transmission of HIV in Yunnan Province, China
title_fullStr Cost-effectiveness of option B+ in prevention of mother-to-child transmission of HIV in Yunnan Province, China
title_full_unstemmed Cost-effectiveness of option B+ in prevention of mother-to-child transmission of HIV in Yunnan Province, China
title_short Cost-effectiveness of option B+ in prevention of mother-to-child transmission of HIV in Yunnan Province, China
title_sort cost-effectiveness of option b+ in prevention of mother-to-child transmission of hiv in yunnan province, china
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560771/
https://www.ncbi.nlm.nih.gov/pubmed/31185927
http://dx.doi.org/10.1186/s12879-019-3976-5
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