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Cost-effectiveness of integrating postpartum antiretroviral therapy and infant care into maternal & child health services in South Africa

Author

Listed:
  • Caitlin M Dugdale
  • Tamsin K Phillips
  • Landon Myer
  • Emily P Hyle
  • Kirsty Brittain
  • Kenneth A Freedberg
  • Lucy Cunnama
  • Rochelle P Walensky
  • Allison Zerbe
  • Milton C Weinstein
  • Elaine J Abrams
  • Andrea L Ciaranello
  • the MCH-ART Trial Team

Abstract

Background: Poor engagement in postpartum maternal HIV care is a challenge worldwide and contributes to adverse maternal outcomes and vertical transmission. Our objective was to project the clinical and economic impact of integrated postpartum maternal antiretroviral therapy (ART) and pediatric care in South Africa. Methods: Using the CEPAC computer simulation models, parameterized with data from the Maternal and Child Health–Antiretroviral Therapy (MCH-ART) randomized controlled trial, we evaluated the cost-effectiveness of integrated postpartum care for women initiating ART in pregnancy and their children. We compared two strategies: 1) standard of care (SOC) referral to local clinics after delivery for separate standard ART services for women and pediatric care for infants, and 2) the MCH-ART intervention (MCH-ART) of co-located maternal/pediatric care integrated in Maternal and Child Health (MCH) services throughout breastfeeding. Trial-derived inputs included: 12-month maternal retention in care and virologic suppression (SOC: 49%, MCH-ART: 67%), breastfeeding duration (SOC: 6 months, MCH-ART: 8 months), and postpartum healthcare costs for mother-infant pairs (SOC: $50, MCH-ART: $69). Outcomes included pediatric HIV infections, maternal and infant life expectancy (LE), lifetime HIV-related per-person costs, and incremental cost-effectiveness ratios (ICERs; ICER

Suggested Citation

  • Caitlin M Dugdale & Tamsin K Phillips & Landon Myer & Emily P Hyle & Kirsty Brittain & Kenneth A Freedberg & Lucy Cunnama & Rochelle P Walensky & Allison Zerbe & Milton C Weinstein & Elaine J Abrams &, 2019. "Cost-effectiveness of integrating postpartum antiretroviral therapy and infant care into maternal & child health services in South Africa," PLOS ONE, Public Library of Science, vol. 14(11), pages 1-18, November.
    • Handle: RePEc:plo:pone00:0225104
    DOI: 10.1371/journal.pone.0225104
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    References listed on IDEAS

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    1. Gesine Meyer-Rath & Craig van Rensburg & Bruce Larson & Lise Jamieson & Sydney Rosen, 2017. "Revealed willingness-to-pay versus standard cost-effectiveness thresholds: Evidence from the South African HIV Investment Case," PLOS ONE, Public Library of Science, vol. 12(10), pages 1-9, October.
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    4. Andrew H. Briggs & Milton C. Weinstein & Elisabeth A. L. Fenwick & Jonathan Karnon & Mark J. Sculpher & A. David Paltiel, 2012. "Model Parameter Estimation and Uncertainty Analysis," Medical Decision Making, , vol. 32(5), pages 722-732, September.
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