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Cost-Effectiveness Analysis of Option B+ for HIV Prevention and Treatment of Mothers and Children in Malawi

Author

Listed:
  • Olufunke Fasawe
  • Carlos Avila
  • Nathan Shaffer
  • Erik Schouten
  • Frank Chimbwandira
  • David Hoos
  • Olive Nakakeeto
  • Paul De Lay

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. Methods: 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. Results: 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. Conclusion: 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.

Suggested Citation

  • Olufunke Fasawe & Carlos Avila & Nathan Shaffer & Erik Schouten & Frank Chimbwandira & David Hoos & Olive Nakakeeto & Paul De Lay, 2013. "Cost-Effectiveness Analysis of Option B+ for HIV Prevention and Treatment of Mothers and Children in Malawi," PLOS ONE, Public Library of Science, vol. 8(3), pages 1-10, March.
    • Handle: RePEc:plo:pone00:0057778
    DOI: 10.1371/journal.pone.0057778
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    Cited by:

    1. Masiano, Steven P. & Kawende, Bienvenu & Ravelomanana, Noro Lantoniaina Rosa & Green, Tiffany L. & Dahman, Bassam & Thirumurthy, Harsha & Kimmel, April D. & Yotebieng, Marcel, 2023. "Economic costs and cost-effectiveness of conditional cash transfers for the uptake of services for the prevention of vertical HIV transmissions in a resource-limited setting," Social Science & Medicine, Elsevier, vol. 320(C).
    2. Monique Abimpaye & Catherine M Kirk & Hari S Iyer & Neil Gupta & Eric Remera & Placidie Mugwaneza & Michael R Law, 2018. "The impact of “Option B” on HIV transmission from mother to child in Rwanda: An interrupted time series analysis," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-7, February.

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