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Table 4 Cost-effectiveness of interventions to reduce mother to child transmission (MTCT) of HIV (2008 I$)1, 2, 3

From: The cost-effectiveness of preventing mother-to-child transmission of HIV in low- and middle-income countries: systematic review

Study Cost per infant HIV infection averted Cost per life year Cost per QALY 4 or DALY 5 Intervention C/E? (benchmark) 6
[32] (1) 3 748 (PPHC)
(1) 1 454 (SOC)
n/a n/a No7
[33] (1) 6 515
(2) 3 401
(3) 1 433
n/a (1) 348
(2) 181
(3) 76
Cost per DALY
Yes
[29] (1) 7 368
(2) 7 095
(3) 3 162
(1) 260; 452
(2) 251; 435
(3) 112; 194
All reported as 3%; 6% discount rate.
n/a Yes
[34] (1) 373
(2) 173
(3) 3 479
(4) 1 582
(5) 1 387
n/a (1) 14
(2) 7
(3) 132
(4) 60
(5) 52
Cost per DALY
Yes (WDR8)
[30] (1) 4 503
(2) 5 879
(3) 25 083
(4) 7 464
(5) 3 053
(6) 315
(7) CS9
(8) CS
(9) 837
(1) 250
(2) 323
(3) 1 390
(4) 414
(5) 167
(6) 18
(7) CS
(8) CS
(9) 46
n/a Yes (WDR)
[35] (1) 1 044
(2) 1 021
(3) 1 196
(4) 1 021
From $5-$141 n/a Yes
[36] 1 787 n/a 17 per DALY Yes
[37] n/a (1) 23
(2) 23
(3) 163
(4) 18 363
n/a Yes
[23] (0) 99 430
(1) 99 318
(2) 61 286
(3) 64 732
(4) 65 733
n/a n/a No10
[25] BWA: 2 022
CIV: 10 354
KEN: 4 800
RWA: 2 089
TZA: 2 554
UGA: 5 432
ZMB: 2 870
ZWE: 3 996
n/a BWA: 65
CIV: 347
KEN: 157
RWA: 74
TZA: 86
UGA: 188
ZMB: 96
ZWE: 129
per DALY
Yes
[31] n/a n/a (0) 1.96
(1) 1.98
(2) 3.25
(3) 2.98
(4) 2.46
(5) 3.60
per QALY
Yes (WDR)
[27] (0) 716
(1) 851
(2) 570
(3) 556
(4) 1 740
(5) 1 776
(6) 1 381
(7) 1 266
n/a n/a Yes (Thai12)
[22] (1) 1 824.61
(2) 709.30
(1) 136.91
(2) 64.18
n/a Yes (WDR), but relative cost-effectiveness is questionable10
[24] (1) 857
(2) 663
n/a n/a No13
[28] n/a n/a (1) CS
(2) 65
(3) CS
(4) 0.5
(5) CS
(6) 12.94
Incremental costs per QALY
Yes (WDR)
[26] n/a n/a (0) 15.34
(1) 15.39
per DALY
Yes
[38] (0) $543
(1) $359 (additional cost for family planning)
n/a n/a Yes
[40] (1) 27 409
(2) 7 361
n/a (1) Dominated
(2) 293 per DALY
Yes/1* GDP per capita per DALY14
[39] (1) $1010 (PRO)
(1) -$267 (PPHC)
n/a (1) $36 (PRO)
(1) -$17 (PPHC) per DALY
Yes/$50 per DALY8and 1* GDP per capita per DALY14
  1. 1 To enhance comparability, all costs in this table are presented in 2008 International dollars (I$) using GDP deflators and purchasing power parities available from the International Monetary Fund [54].
  2. 2 Numbers in round brackets correspond to the intervention strategies presented in Table 1. Although several studies comparing multiple strategies also provide incremental results [2729, 40], results comparing individual strategies to a do-nothing alternative are presented where possible. The exception is [28].
  3. 3 SOC = Societal (considers direct and indirect costs); PPHC = Public payer of healthcare costs (considers direct costs only); PRO = Provider (considers direct medical costs covered by the facility)
  4. 4 QALY = Quality-adjusted life years
  5. 6 DALY = Disability-adjusted life years
  6. 6 These are the study authors' conclusions about the value of one or more interventions to prevent MTCT of HIV. If a benchmark was used to justify the conclusion, it is provided in brackets.
  7. 7 Study based on older (higher) drug prices and lower regimen effectiveness.
  8. 8 The 1993 World Development Report: Investing in Health proposed that interventions costing less than $100 per life year saved are cost effective for middle-income countries while $50 per life-year gained is a reasonable benchmark for low-income countries [33]. This was updated to $64 per QALY in low-income settings ($50 per QALY gained, adjusted to 2003 dollars) by [26] and [29].
  9. 9 CS = Cost saving
  10. 10 Concentrated epidemic; very low HIV prevalence.
  11. 11 Three-letter country codes published by the International Organization for Standardization (ISO). See Table 3.
  12. 12 Authors used the Thai health system's thresholds for adopting health technologies as a benchmark.
  13. 13Authors' conclusions comparing the effectiveness of an ARV-based regimen (pMTCT component 3) to a family planning strategy (pMTCT component 1). Both strategies would likely be cost-effective using standard benchmarks.
  14. 14 The WHO Commission on Macroeconomics in Health proposed that interventions costing 1*GDP per capita per DALY should be considered "very cost-effective", while those costing <3*GDP per capita should be considered "cost-effective" [44].