By the same authors

From the same journal

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

Research output: Contribution to journalArticle

Author(s)

  • Mairin Ryan
  • Susan Griffin
  • Bona Chitah
  • A. Sarah Walker
  • Veronica Mulenga
  • Donald Kalolo
  • Neil Hawkins
  • Concepta Merry
  • Michael G. Barry
  • Chifumbe Chintu
  • Mark J. Sculpher
  • Diana M. Gibb

Department/unit(s)

Publication details

JournalAids
DatePublished - 30 Mar 2008
Issue number6
Volume22
Number of pages9
Pages (from-to)749-757
Original languageEnglish

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.

    Research areas

  • Africa, children, cost-effectiveness, cotrimoxazole prophylaxis, HIV/AIDS, COTE-DIVOIRE, TRIMETHOPRIM-SULFAMETHOXAZOLE, ANTIRETROVIRAL THERAPY, TRIAL, MORTALITY, UGANDA, LIFE, INTERVENTIONS, MORBIDITY

Discover related content

Find related publications, people, projects, datasets and more using interactive charts.

View graph of relations