COST-EFFECTIVENESS OF AN INTEGRATED TEST TO ACCELERATE THE TRIPLE ELIMINATION OF HIV, SYPHILIS AND HEPATITIS B IN NIGERIA
Author(s)
Donald S. Shepard, PhD, MPP, FASTMH1, Abed Abdulrahman, MD, MS1, Isaiah Dzimbiri, BPharm1, Pacifique Dusabeyezu, PT1, Missiani Ochwoto, PhD2, Michael Kingsley, MD3.
1Brandeis University, Waltham, MA, USA, 2Kenya Medical Research Institute, Nairobi, Kenya, 3Federal Ministry of Health, Abuja, Nigeria.
1Brandeis University, Waltham, MA, USA, 2Kenya Medical Research Institute, Nairobi, Kenya, 3Federal Ministry of Health, Abuja, Nigeria.
OBJECTIVES: Following the World Health Organization’s recommendations, Nigeria is working to eliminate three vertical (mother-to-newborn) infections: human immunodeficiency virus (HIV), syphilis and hepatitis B (HBV). Except for HIV, current testing coverage in antenatal care (ANC) is low. A recently approved integrated test detects all three infections, including both HIV antibody and p24 antigen (for acute-phase infections). We modeled the health and economic impacts of introducing this integrated test for Nigeria’s 6.4 million (M) women entering ANC annually.
METHODS: We developed a deterministic model with risks of infection and illness for both mother and infant and applied it to current and future conditions using a healthcare perspective. We estimated prevalence rates, treatment rates, efficacy, health sector diagnostic and treatment costs by payer, and lifetime Disability Adjusted Life Years (DALYs) for each illness from program data, literature, and, where necessary, expert judgment.
RESULTS: Nigeria currently experiences 288,270 vertical infections annually. The integrated test would increase screening for each infection, with the biggest gain for HBV, rising from 0.83 to 4.29M women annually. The modeled process would avert 53,872 vertical transmissions annually from detections of HIV antibody (1,540), HIV p24 antigen (4,784), syphilis (1,471) and HBV (46,076). The process would avert 1,246,000 DALYs altogether annually (519,000 in infants and 727,000 in women). The annual overall net cost from the predicted expansion in testing and treatment is $89.5M ($62.0M from public payers and $27.5M from families). The overall incremental cost-effectiveness ratio (ICER) is $72/DALY averted.
CONCLUSIONS: The net cost ($14/woman in ANC) appears affordable. The ICER is substantially below both the $137 cutoff threshold for Nigeria based on the country’s past healthcare spending (Pichon-Riviere et al, 2023) and its $807 GDP/capita. This integrated test and its associated expansion in treatment of mothers and infants would be highly cost-effective and deserves serious consideration by stakeholders.
METHODS: We developed a deterministic model with risks of infection and illness for both mother and infant and applied it to current and future conditions using a healthcare perspective. We estimated prevalence rates, treatment rates, efficacy, health sector diagnostic and treatment costs by payer, and lifetime Disability Adjusted Life Years (DALYs) for each illness from program data, literature, and, where necessary, expert judgment.
RESULTS: Nigeria currently experiences 288,270 vertical infections annually. The integrated test would increase screening for each infection, with the biggest gain for HBV, rising from 0.83 to 4.29M women annually. The modeled process would avert 53,872 vertical transmissions annually from detections of HIV antibody (1,540), HIV p24 antigen (4,784), syphilis (1,471) and HBV (46,076). The process would avert 1,246,000 DALYs altogether annually (519,000 in infants and 727,000 in women). The annual overall net cost from the predicted expansion in testing and treatment is $89.5M ($62.0M from public payers and $27.5M from families). The overall incremental cost-effectiveness ratio (ICER) is $72/DALY averted.
CONCLUSIONS: The net cost ($14/woman in ANC) appears affordable. The ICER is substantially below both the $137 cutoff threshold for Nigeria based on the country’s past healthcare spending (Pichon-Riviere et al, 2023) and its $807 GDP/capita. This integrated test and its associated expansion in treatment of mothers and infants would be highly cost-effective and deserves serious consideration by stakeholders.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE334
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Infectious Disease (non-vaccine), SDC: Pediatrics, SDC: Reproductive & Sexual Health, STA: Vaccines