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


Autoři: Caitlin M. Dugdale aff001;  Tamsin K. Phillips aff004;  Landon Myer aff004;  Emily P. Hyle aff001;  Kirsty Brittain aff004;  Kenneth A. Freedberg aff001;  Lucy Cunnama aff008;  Rochelle P. Walensky aff001;  Allison Zerbe aff009;  Milton C. Weinstein aff007;  Elaine J. Abrams aff009;  Andrea L. Ciaranello aff001
Působiště autorů: Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America aff001;  Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States of America aff002;  Harvard Medical School, Boston, MA, United States of America aff003;  Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa aff004;  Centre for Infectious Diseases Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa aff005;  Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, United States of America aff006;  Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America aff007;  Health Economics Unit, School of Public Health & Family Medicine, University of Cape Town, South Africa aff008;  ICAP at Columbia and the Mailman School of Public Health, Columbia University, New York, NY, United States of America aff009;  College of Physicians & Surgeons, Columbia University, New York, NY, United States of America aff010
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225104

Souhrn

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 <US$903/YLS considered “cost-effective”).

Results

Compared to SOC, MCH-ART increased maternal LE (SOC: 25.26 years, MCH-ART: 26.20 years) and lifetime costs (SOC: $9,912, MCH-ART: $10,207; discounted). Projected pediatric outcomes for all HIV-exposed children were similar between arms, although undiscounted LE for HIV-infected children was shorter in SOC (SOC: 23.13 years, MCH-ART: 23.40 years). Combining discounted maternal and pediatric outcomes, the ICER was $599/YLS.

Conclusion

Co-located maternal HIV and pediatric care, integrated in MCH services throughout breastfeeding, is a cost-effective strategy to improve maternal and pediatric outcomes and should be implemented in South Africa.

Klíčová slova:

Cost-effectiveness analysis – Infants – Pediatric infections – Pediatrics – South Africa


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