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.

• Authors: Máirín 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
• Journal: AIDS (London, England) (AIDS) Vol. 22 Issue 6 Pg. 749-57 (Mar 30 2008) ISSN: 1473-5571 [Electronic] England
• PMID: 18356605 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Trimethoprim, Sulfamethoxazole Drug Combination

Topics

• Adolescent
• Child
• Child, Preschool
• Cost-Benefit Analysis
• Developing Countries
• Drug Costs
• Female
• Follow-Up Studies
• HIV
• HIV Infections (economics, prevention & control)
• Humans
• Infant
• Male
• Markov Chains
• Quality-Adjusted Life Years
• Randomized Controlled Trials as Topic
• Treatment Outcome
• Trimethoprim, Sulfamethoxazole Drug Combination (economics, therapeutic use)
• Zambia