Costs and benefits of multidrug, multidose antiretroviral therapy for prevention of mother-to-child transmission of HIV in the Dominican Republic
Schmidt, N.C.; Roman-Pouriet, Jé.; Fernandez, A.D.; Beck-Sagué, C.M.; Leonardo-Guerrero, Jé.; Nicholas, S.W.
International Journal of Gynaecology and Obstetrics the Official Organ of the International Federation of Gynaecology and Obstetrics 116(3): 219-222
2012
ISSN/ISBN: 0020-7292 PMID: 22196992 DOI: 10.1016/j.ijgo.2011.10.028Document Number: 552800
To investigate whether costs of multidose antiretroviral regimens (MD-ARVs), including highly active antiretroviral therapy (HAART), for prevention of mother-to-child transmission (PMTCT) of HIV might be offset by savings gained from treating fewer perinatally acquired infections. Rates of MTCT reported in the Dominican Republic among mother-infant pairs treated with single-dose nevirapine (SD-NVP; n=39) and MD-ARVs (n=91) for PMTCT were compared. Annual births to women infected with HIV were estimated from seroprevalence studies. Antiretroviral costs for both PMTCT and for HAART during the first 2 years of life (in cases of perinatal infection) were based on 2008 low-income country price estimates. Rates of MTCT were 3.3% and 15.4% for the MD-ARV and SD-NVP groups, respectively (P=0.02). Assuming that 5775 of 231 000 annual births (2.5%) were to HIV-positive women, it was estimated that 191 perinatally acquired infections would occur using MD-ARVs and 889 using SD-NVP. High costs of maternal MD-ARVs (HAART, US$914,760 versus SD-NVP, $1155) would be offset by lower 2-year HAART costs ($250,344 versus $1,168,272 for infants in the SD-NVP group) for the lower number of children with prenatally acquired infection (191 versus 889) associated with the use of MD-ARVs for PMTCT (net national saving $3168). Despite the high costs, use of MD-ARVs, such as HAART, for PMTCT offer societal savings because fewer perinatally acquired infections are anticipated to require treatment.
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