Skip to main content

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 [27–29, 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].