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Costs and benefits of multidrug, multidose antiretroviral therapy for prevention of mother‐to‐child transmission of HIV in the Dominican Republic
Author(s) -
Schmidt Nicole C.,
RomanPouriet José,
Fernandez Aracelis D.,
BeckSagué Consuelo M.,
LeonardoGuerrero José,
Nicholas Stephen W.
Publication year - 2012
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2011.10.028
Subject(s) - medicine , nevirapine , antiretroviral therapy , human immunodeficiency virus (hiv) , transmission (telecommunications) , antiretroviral treatment , pediatrics , breastfeeding , obstetrics , viral load , immunology , electrical engineering , engineering
Abstract Objective To investigate whether costs of multidose antiretroviral regimens (MD‐ARVs), including highly active antiretroviral therapy (HAART), for prevention of mother‐to‐child transmission (PMTCT) of HIV might be offset by savings gained from treating fewer perinatally acquired infections. Methods Rates of MTCT reported in the Dominican Republic among mother‐infant pairs treated with single‐dose nevirapine (SD‐NVP; n = 39) and MD‐ARVs (n = 91) for PMTCT were compared. Annual births to women infected with HIV were estimated from seroprevalence studies. Antiretroviral costs for both PMTCT and for HAART during the first 2 years of life (in cases of perinatal infection) were based on 2008 low‐income country price estimates. Results Rates of MTCT were 3.3% and 15.4% for the MD‐ARV and SD‐NVP groups, respectively ( P = 0.02). Assuming that 5775 of 231 000 annual births (2.5%) were to HIV‐positive women, it was estimated that 191 perinatally acquired infections would occur using MD‐ARVs and 889 using SD‐NVP. High costs of maternal MD‐ARVs (HAART, US$914,760 versus SD‐NVP, $1155) would be offset by lower 2‐year HAART costs ($250,344 versus $1,168,272 for infants in the SD‐NVP group) for the lower number of children with prenatally acquired infection (191 versus 889) associated with the use of MD‐ARVs for PMTCT (net national saving $3168). Conclusion Despite the high costs, use of MD‐ARVs, such as HAART, for PMTCT offer societal savings because fewer perinatally acquired infections are anticipated to require treatment.