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In-person registration included the full virtual experience, and virtual-only attendees will be able to tune into live in-person sessions and/or watch captured in-person sessions on-demand in addition to having a variety of virtual-only sessions to attend.

Cost-Effectiveness of Tenofovir/Lamivudine/Efavirenz Versus Tenofovir/Lamivudine/Dolutegravir for Preventing Mother-to-Child Transmission of HIV in Nigeria

Speaker(s)

Ndai A1, Guo Y2, Jiao T2, Aroza R2, Park H3, Shao H2, Vouri SM4
1University of Florida, Gainesville , FL, USA, 2University of Florida, Gainesville, FL, USA, 3Center for Drug Evaluation & Safety, Department of Pharmaceutical Outcomes and Policy, Gainesville, FL, USA, 4University of Florida, College of Pharmacy, Gainesville, FL, USA

Presentation Documents

Introduction: The World Health Organization (WHO) recommended using Tenofovir/Lamivudine/Dolutegravir (TLD) over Tenofovir/Lamivudine/Efavirenz (TLE) in pregnant women living with HIV. Albeit TLD is cheaper than TLE, studies have reported safety concern among pregnant women. This study aimed to evaluate the cost-effectiveness of TLD vs. TLE to prevent mother-to-child transmission of HIV in pregnant women in Nigeria.

Methods: We developed a Markov model to estimate health outcomes (Disability-Adjusted Life Years (DALY)) of TLD vs. TLE in all HIV-positive pregnant women needing antiretroviral from a payer’s perspective. Effectiveness data were derived from published studies and sources (risk of transmission with TLE (0.07%) and TLD (0.00%)). Three health states of children born to HIV-infected mothers were included: healthy, HIV-infected (vertical transmission), and death (stillbirth and neonatal death). The annual cost of TLD, TLE, and antiretroviral for pediatrics were $66, $69, and $236, respectively. The Willingness-To-Pay (WTP) per DALY averted was estimated using WHO-CHOICE at the GDP/capita ($2097). Costs discounted at an annual rate of 3%. Outcomes were modeled for 5 years, incremental cost-effectiveness ratios (ICERs) were calculated for TLD compared to TLE.

Results: Our study included 147,942 women. The total cost of TLE and TLD was $104 and $101 per patient. Compared to TLE, TLD averted 296 vertical transmission of HIV infection and 118 neonatal deaths, but increased stillbirth by 122. TLD was a dominant choice over TLE, with $24 per DALYs averted for their children. Results from sensitivity analysis show that our conclusion is robust to parameter uncertainties.

Conclusion: Our results suggest that use of TLE over TLD for pregnant women living with HIV will improve the health of children born to HIV-infected mothers with reductions in cost in Nigeria.

Code

EE10

Topic

Economic Evaluation, Epidemiology & Public Health, Health Policy & Regulatory, Study Approaches

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis, Decision Modeling & Simulation, Public Health, Public Spending & National Health Expenditures

Disease

Drugs