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

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The cost-effectiveness of cotrimoxazole prophylaxis in HIV-infected children in Zambia. / Ryan, Mairin; Griffin, Susan; Chitah, Bona; Walker, A. Sarah; Mulenga, Veronica; Kalolo, Donald; Hawkins, Neil; Merry, Concepta; Barry, Michael G.; Chintu, Chifumbe; Sculpher, Mark J.; Gibb, Diana M.

In: Aids, Vol. 22, No. 6, 30.03.2008, p. 749-757.

Research output: Contribution to journalArticle

Harvard

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, vol. 22, no. 6, pp. 749-757. https://doi.org/10.1097/QAD.0b013e3282f43519

APA

Ryan, M., Griffin, S., Chitah, B., Walker, A. S., Mulenga, V., Kalolo, D., ... Gibb, D. M. (2008). The cost-effectiveness of cotrimoxazole prophylaxis in HIV-infected children in Zambia. Aids, 22(6), 749-757. https://doi.org/10.1097/QAD.0b013e3282f43519

Vancouver

Ryan M, Griffin S, Chitah B, Walker AS, Mulenga V, Kalolo D et al. The cost-effectiveness of cotrimoxazole prophylaxis in HIV-infected children in Zambia. Aids. 2008 Mar 30;22(6):749-757. https://doi.org/10.1097/QAD.0b013e3282f43519

Author

Ryan, Mairin ; Griffin, Susan ; Chitah, Bona ; Walker, A. Sarah ; Mulenga, Veronica ; Kalolo, Donald ; Hawkins, Neil ; Merry, Concepta ; Barry, Michael G. ; Chintu, Chifumbe ; Sculpher, Mark J. ; Gibb, Diana M. / The cost-effectiveness of cotrimoxazole prophylaxis in HIV-infected children in Zambia. In: Aids. 2008 ; Vol. 22, No. 6. pp. 749-757.

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@article{826b506b18114a6dad182beb8cb5c954,
title = "The cost-effectiveness of cotrimoxazole prophylaxis in HIV-infected children in Zambia",
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.",
keywords = "Africa, children, cost-effectiveness, cotrimoxazole prophylaxis, HIV/AIDS, COTE-DIVOIRE, TRIMETHOPRIM-SULFAMETHOXAZOLE, ANTIRETROVIRAL THERAPY, TRIAL, MORTALITY, UGANDA, LIFE, INTERVENTIONS, MORBIDITY",
author = "Mairin Ryan and Susan Griffin and Bona Chitah and Walker, {A. Sarah} and Veronica Mulenga and Donald Kalolo and Neil Hawkins and Concepta Merry and Barry, {Michael G.} and Chifumbe Chintu and Sculpher, {Mark J.} and Gibb, {Diana M.}",
year = "2008",
month = "3",
day = "30",
doi = "10.1097/QAD.0b013e3282f43519",
language = "English",
volume = "22",
pages = "749--757",
journal = "Aids",
issn = "0269-9370",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

RIS (suitable for import to EndNote) - Download

TY - JOUR

T1 - The cost-effectiveness of cotrimoxazole prophylaxis in HIV-infected children in Zambia

AU - Ryan, Mairin

AU - Griffin, Susan

AU - Chitah, Bona

AU - Walker, A. Sarah

AU - Mulenga, Veronica

AU - Kalolo, Donald

AU - Hawkins, Neil

AU - Merry, Concepta

AU - Barry, Michael G.

AU - Chintu, Chifumbe

AU - Sculpher, Mark J.

AU - Gibb, Diana M.

PY - 2008/3/30

Y1 - 2008/3/30

N2 - 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.

AB - 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.

KW - Africa

KW - children

KW - cost-effectiveness

KW - cotrimoxazole prophylaxis

KW - HIV/AIDS

KW - COTE-DIVOIRE

KW - TRIMETHOPRIM-SULFAMETHOXAZOLE

KW - ANTIRETROVIRAL THERAPY

KW - TRIAL

KW - MORTALITY

KW - UGANDA

KW - LIFE

KW - INTERVENTIONS

KW - MORBIDITY

UR - http://www.scopus.com/inward/record.url?scp=41349095283&partnerID=8YFLogxK

U2 - 10.1097/QAD.0b013e3282f43519

DO - 10.1097/QAD.0b013e3282f43519

M3 - Article

VL - 22

SP - 749

EP - 757

JO - Aids

T2 - Aids

JF - Aids

SN - 0269-9370

IS - 6

ER -