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. (C) 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins.
| Original language | English |
|---|---|
| Pages (from-to) | 749-757 |
| Number of pages | 9 |
| Journal | Aids |
| Volume | 22 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - 30 Mar 2008 |
Keywords
- Africa
- children
- cost-effectiveness
- cotrimoxazole prophylaxis
- HIV/AIDS
- COTE-DIVOIRE
- TRIMETHOPRIM-SULFAMETHOXAZOLE
- ANTIRETROVIRAL THERAPY
- TRIAL
- MORTALITY
- UGANDA
- LIFE
- INTERVENTIONS
- MORBIDITY