The cost-effectiveness of cotrimoxazole prophylaxis in HIV-infected children in Zambia.


Ryan, M; Griffin, S; Chitah, B; Walker, AS; Mulenga, V; Kalolo, D; Hawkins, N; Merry, C; Barry, MG; Chintu, C; Sculpher, MJ; Gibb, DM; (2008) The cost-effectiveness of cotrimoxazole prophylaxis in HIV-infected children in Zambia. AIDS (London, England), 22. pp. 749-57. ISSN 0269-9370 DOI: https://doi.org/10.1097/QAD.0b013e3282f43519

Full text not available from this repository.

Abstract

OBJECTIVE: To assess the cost-effectiveness of cotrimoxazole prophylaxis in HIV-infected children in Zambia, as implementation at the local health centre level has yet to be undertaken in many resource-limited countries despite recommendations in recent updated World Health Organization (WHO) guidelines. DESIGN: A probabilistic decision analytical model of HIV/AIDS progression in children based on the CD4 cell percentage (CD4%) was populated with data from the placebo-controlled Children with HIV Antibiotic Prophylaxis trial that had reported a 43% reduction in mortality with cotrimoxazole prophylaxis in HIV-infected children aged 1-14 years. METHODS: Unit costs (US$ in 2006) were measured at University Teaching Hospital, Lusaka. Cost-effectiveness expressed as cost per life-year saved, cost per quality adjusted life-year (QALY) saved, cost per disability adjusted life-year (DALY) averted was calculated across a number of different scenarios at tertiary and primary healthcare centres. RESULTS: : Cotrimoxazole prophylaxis was associated with incremental cost-effectiveness ratios (ICERs) of US$72 per life-year saved, US$94 per QALY saved and US$53 per DALY averted, i.e. substantially less than a cost-effectiveness threshold of US$1019 per outcome (gross domestic product per capita, Zambia 2006). ICERs of US$5 or less per outcome demonstrate that cotrimoxazole prophylaxis is even more cost-effective at the local healthcare level. The intervention remained cost-effective in all sensitivity analyses including routine haematological and CD4% monitoring, varying starting age, AIDS status, cotrimoxazole formulation, efficacy duration and discount rates. CONCLUSION: Cotrimoxazole prophylaxis in HIV-infected children is an inexpensive low technology intervention that is highly cost-effective in Zambia, strongly supporting the adoption of WHO guidelines into essential healthcare packages in low-income countries.

Item Type: Article
Keywords: Adolescent, Child, Child, Preschool, Cost-Benefit Analysis, Developing Countries, Drug Costs, Female, Follow-Up Studies, HIV, HIV Infections, HIV Infections: economics, HIV Infections: prevention & control, Humans, Infant, Male, Markov Chains, Quality-Adjusted Life Years, Randomized Controlled Trials as Topic, Treatment Outcome, Trimethoprim-Sulfamethoxazole Combination, Trimethoprim-Sulfamethoxazole Combination: economi, Trimethoprim-Sulfamethoxazole Combination: therape, Zambia, Adolescent, Child, Child, Preschool, Cost-Benefit Analysis, Developing Countries, Drug Costs, Female, Follow-Up Studies, HIV, HIV Infections, economics, prevention & control, Humans, Infant, Male, Markov Chains, Quality-Adjusted Life Years, Randomized Controlled Trials as Topic, Treatment Outcome, Trimethoprim, Sulfamethoxazole Drug Combination, economics, therapeutic use, Zambia
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
PubMed ID: 18356605
Web of Science ID: 255218800010
URI: http://researchonline.lshtm.ac.uk/id/eprint/2534614

Statistics


Download activity - last 12 months
Downloads since deposit
0Downloads
70Hits
Accesses by country - last 12 months
Accesses by referrer - last 12 months
Impact and interest
Additional statistics for this record are available via IRStats2

Actions (login required)

Edit Item Edit Item