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National and provincial estimated costs and cost effectiveness of a programme to reduce mother-to-child HIV transmission in South Africa |
Wilkinson D, Floyd K, Gilks C F |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology A programme to reduce mother-to-child HIV transmission in South Africa.
Economic study type Cost-effectiveness analysis and cost-utility analysis.
Study population The study population consisted of HIV-infected pregnant women in South Africa.
Setting The setting was the community and hospitals. The economic study was conducted in South Africa.
Dates to which data relate Effectiveness and resource use data were collected from studies published between 1994 and 1998. Cost data were taken from a study published in 1998. The price year was 1997.
Source of effectiveness data Effectiveness data were derived from a literature review.
Modelling A decision analytic model was used to determine the cost-effectiveness of the ZDV programme.
Outcomes assessed in the review The review assessed attendance for antenatal care, HIV testing, MTCT rate, and life expectancy.
Study designs and other criteria for inclusion in the review Sources searched to identify primary studies Criteria used to ensure the validity of primary studies Methods used to judge relevance and validity, and for extracting data Summary statistics from individual studies were used.
Number of primary studies included At least four primary studies were included.
Methods of combining primary studies Primary studies were combined using the narrative method.
Investigation of differences between primary studies Results of the review Health promotion was assumed to be successful and only 2.5% of pregnant women would not attend antenatal care. 75% of women accept testing, receive the result, and receive the intervention. The MTCT rate among these women is 15%. The remaining 25% do not receive ZDV and experience a 30% MTCT rate. Life expectancy was 69 years.
Measure of benefits used in the economic analysis The number of infections averted and the number of disability-adjusted life years (DALYs) gained were used as the measures of benefit.
Direct costs Direct costs were not discounted, as the time horizon was less than 1 year. Quantities and costs were reported separately. Direct costs included drug costs, formula feed costs, HIV test costs, and the costs of extra staff, training, and health education. The quantity/cost boundary adopted was that of the health service. The estimation of quantities and costs was based on actual data. Costs and quantities were obtained from a previously published study. The price year was 1997.
Statistical analysis of costs No statistical analysis of costs was reported.
Indirect Costs Indirect costs were not included.
Sensitivity analysis Sensitivity analyses were conducted on the reduction in the number of paediatric HIV infections and life expectancy.
Estimated benefits used in the economic analysis HIV prevalence was 16.01% nationally, varying from 8.2% to 26.92% in the provinces. The number of pregnant women was 1,340,797 nationally, varying from 21,547 to 301,048 in the provinces. The expected number of HIV infections was 63,397 nationally, varying from 558 to 18,513 in the provinces. The number of HIV infections prevented with the programme was 23,181 nationally, varying from 204 to 6,769 in the provinces.
Cost results Total programme costs amounted to R155,872,008 nationally, varying from R1,937,032 to R37,620,875 in the provinces. Expressed as a percentage of the health budget, this was equivalent to 0.94% nationally, varying from 0.38% to 1.88 % in the provinces.
Synthesis of costs and benefits The cost per HIV infection averted was R6,724 nationally, varying from R4,232 to R11,656 in the provinces. The cost per DALY was R213 nationally, varying from R134 to R369 in the provinces.
Authors' conclusions A national programme to reduce mother-to-child HIV transmission in South Africa is potentially affordable and cost-effective. Cost-effectiveness is greatest where HIV prevalence is highest.
CRD COMMENTARY - Selection of comparators A justification was given for the comparators used, namely no intervention. You, as a user of the database, should decide if these health technologies are relevant to your setting.
Validity of estimate of measure of effectiveness The authors undertook a literature review to derive estimates for the model, which seemed appropriate, although they did not state that a systematic review of the literature had been undertaken. More information about the methods of the review could have been provided. The validity of the results was enhanced by sensitivity analyses on some effectiveness estimates to account for variability in the estimates. The authors extrapolated effectiveness estimates from one particular province to the rest of South Africa, although conditions may vary across South Africa.
Validity of estimate of measure of benefit The estimation of the number of HIV infections averted was obtained directly from the effectiveness analysis. The estimation of DALYs was modelled. The instrument used to derive DALYs and the source of DALY values were not reported.
Validity of estimate of costs Good features of the cost analysis were that all relevant direct cost categories were included, quantities and costs were reported separately, and the price year was reported. However, the authors did not conduct sensitivity analyses on direct costs, thereby limiting the generalisability of the cost results. The authors did not include indirect costs, such as savings in health service costs, that a MTCT programme would inevitably generate.
Other issues The authors did not make appropriate comparisons of their findings with those from other studies but did address the issue of generalisability to other settings. The authors did not present their results selectively. The study considered HIV-infected pregnant women in South Africa and this was reflected in the authors' conclusions. The authors acknowledged that they did not consider activity in the private sector and the potentially negative impact of bottle-feeding on the community, its health, and the costs of health care. These factors may be of interest in future studies in this particular clinical area.
Implications of the study A national programme to reduce mother-to-child HIV transmission in South Africa is potentially affordable and cost-effective. Cost-effectiveness is greatest where HIV prevalence is highest.
Bibliographic details Wilkinson D, Floyd K, Gilks C F. National and provincial estimated costs and cost effectiveness of a programme to reduce mother-to-child HIV transmission in South Africa. South African Medical Journal 2000; 90(8): 794-798 Indexing Status Subject indexing assigned by NLM MeSH AIDS Serodiagnosis /economics; Anti-HIV Agents /economics /therapeutic use; Cost-Benefit Analysis; Disabled Persons; Female; Forecasting; HIV Infections /diagnosis /economics /epidemiology /prevention & HIV Seroprevalence; Health Services Research; Humans; Infant Food /economics; Infectious Disease Transmission, Vertical /economics /prevention & Maternal Health Services /organization & Models, Econometric; National Health Programs /organization & Program Evaluation; Quality-Adjusted Life Years; Sensitivity and Specificity; South Africa /epidemiology; Zidovudine /economics /therapeutic use; administration; administration; control; control /transmission AccessionNumber 22000001565 Date bibliographic record published 31/10/2001 Date abstract record published 31/10/2001 |
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