A review of studies assessing the costs and consequences of interventions to reduce mother-to-child HIV transmission in sub-Saharan Africa

Abstract

Objective: To review the methods and findings of studies that assess the costs and consequences of interventions to reduce mother-to-child HIV transmission in sub-Saharan Africa.

Design: Systematic literature review.

Methods: A literature search was conducted to identify studies that assessed the costs and consequences of interventions aimed at reducing mother-to-child HIV transmission in African populations. The methodological quality of included studies was appraised using the British Medical Journal Economic Evaluation Working Party checklist and data were extracted for comparison using a data extraction template.

Results: Nine studies, all of which used modelling techniques to predict the cost-effectiveness of anti-retroviral interventions, were identified for inclusion in the review. The quality of reporting was found to be lacking in several key areas. In particular a lack of detail was given regarding quantities of resources required for interventions, and the methods for valuing health outcomes and unit costs. In general, the more recent evaluations report more favourable cost-effectiveness ratios than earlier studies due to lower drug costs and in some cases the use of shorter drug regimens.

Conclusions: Comparisons between studies were hampered by variations in the values attached to model parameters and by differences in the structure and design of models. The most encouraging findings have been reported for the CDC short zidovudine regimen and the HIVNET012 single dose nevirapine regimen. The generalizability of these findings is limited by the use of incremental costing, combined with uncertainty surrounding the level of infrastructure required to implement the interventions. In low-income sub-Saharan countries, the costs of strengthening the infrastructure to levels capable of providing such interventions, needs to be assessed before an optimal policy for the prevention of mother-to-child HIV transmission in sub-Saharan Africa can be established.