Cost-effectiveness of pre-exposure HIV prophylaxis during pregnancy and breastfeeding in Sub-Saharan Africa

Joan T. Price, Stephanie B. Wheeler, Lynda Stranix-Chibanda, Sybil G. Hosek, D. Heather Watts, George K. Siberry, Hans M.L. Spiegel, Jeffrey S. Stringer, Benjamin H. Chi

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Antiretroviral pre-exposure prophylaxis (PrEP) for the prevention of HIV acquisition is cost-effective when delivered to those at substantial risk. Despite a high incidence of HIV infection among pregnant and breastfeeding women in sub-Saharan Africa (SSA), a theoretical increased risk of preterm birth on PrEP could outweigh the HIV prevention benefit. Methods: We developed a decision analytic model to evaluate a strategy of daily oral PrEP during pregnancy and breastfeeding in SSA. We approached the analysis from a health care system perspective across a lifetime time horizon. Model inputs were derived from existing literature and local sources. The incremental cost-effectiveness ratio (ICER) of PrEP versus no PrEP was calculated in 2015 U.S. dollars per disability-adjusted life year (DALY) averted. We evaluated the effect of uncertainty in baseline estimates through one-way and probabilistic sensitivity analyses. Results: PrEP administered to pregnant and breastfeeding women in SSA was cost-effective. In a base case of 10,000 women, the administration of PrEP averted 381 HIV infections but resulted in 779 more preterm births. PrEP was more costly per person ($450 versus $117), but resulted in fewer disability-adjusted life years (DALYs) (3.15 versus 3.49). The incremental cost-effectiveness ratio of $965/DALY averted was below the recommended regional threshold for cost-effectiveness of $6462/DALY. Probabilistic sensitivity analyses demonstrated robustness of the model. Conclusions: Providing PrEP to pregnant and breastfeeding women in SSA is likely cost-effective, although more data are needed about adherence and safety. For populations at high risk of HIV acquisition, PrEP may be considered as part of a broader combination HIV prevention strategy.

Original languageEnglish (US)
Pages (from-to)S145-S153
JournalJournal of acquired immune deficiency syndromes
Volume72
DOIs
StatePublished - Aug 1 2016

Keywords

  • Breastfeeding
  • Cost-effectiveness
  • HIV prevention
  • Pre-exposure prophylaxis
  • Pregnancy
  • Sub-Saharan Africa

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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