Artigo Acesso aberto Revisado por pares

Cost-effectiveness of strategies to reduce mother-to-child HIV transmission in Mexico, a low-prevalence setting

2003; Oxford University Press; Volume: 18; Issue: 3 Linguagem: Inglês

10.1093/heapol/czg035

ISSN

1460-2237

Autores

Kely Rely, Stefano Bertozzi, Carlos Ávila-Figueroa, Maria Teresa Guijarro,

Tópico(s)

Poverty, Education, and Child Welfare

Resumo

To estimate and compare the cost-effectiveness of selected interventions to reduce mother-to-child transmission (MTCT) of HIV in Mexico.A spreadsheet-based model was used to examine five scenarios, each estimated using both zidovudine (ZDV) and nevirapine (NVP). Scenarios differ according to coverage, type of voluntary counselling and testing (VCT), restriction to women at higher risk, and whether rapid testing is offered at delivery. Averted adult infections due to VCT are also estimated, as are savings due to averted treatment costs. Results are reported as cost per child infection prevented, net of averted treatment costs (C/CIP).Among 958294 women attending public antenatal clinics, increasing VCT coverage from 4% to 85% is estimated to prevent 102 paediatric and 8 adult infections at a C/CIP of US dollars 42517 using ZDV. In the most restrictive scenario (III), 46 paediatric infections are prevented with a C/CIP of US dollars 39220. Use of NVP increases C/CIP because the reduced drug cost is more than offset by its reduced assumed effectiveness. The cost of detecting infected women (approximately 90% of total) far exceeds treatment costs in such a low-prevalence setting.Minimization of MTCT costs in low-prevalence settings should focus on VCT costs rather than drug costs. Even the most cost-effective scenario modelled compares unfavourably with other, highly cost-effective maternal/child interventions that still do not reach many Mexicans. However, it compares favourably against several therapeutic maternal/child interventions available in the public sector's tertiary care hospitals.

Referência(s)