| BackgroundMother to child transmission rate of HIV can be declined to 2% and lower through complex prevention of mother to child transmission interventions. Since 2010, Chinese government increased investment in PMTCT project, which accounted for about one third of all AIDS prevention and control funds. Scientific evaluation with respect to PMTCT strategy is helpful to understand cost effectiveness of this project and provide reliable evidence and information for decision makers to allocate resources.ObjectiveAnalyze the cost effectiveness of HIV PMTCT project in China and explore suitable PMTCT strategy in line with current Chinese economic development level.MethodsWe collected transition rate and cost data through systematic literature research, field survey and experts consulting. We built Markov Model based on above information. Three different PMTCT strategies were set in the model:Complex and Normative PMTCT, Delayed PMTCT and None PMTCT to simulate HIV progression. Cost effective analysis and incremental cost effectiveness analysis were conducted to compute corresponding index. Results from three strategies were compared to explore suitable PMTCT strategy in line with current Chinese economic development level. Moreover, we conducted sensitivity analysis to estimate the model stability.Results1. Cost and effectiveness for CN PMTCT, Delayed PMTCT and None PMTCT are 8,709,349 yuan/2,952,659 QALYs,5,598,963 Yuan /2,952,176 QALYs ? 2,739,870 yuan/2,949,932 QALYs respectively. Cost effectiveness ratio was 2.95, 1.90 and 0.09 for the three strategies. Incremental Cost Effectiveness Ratios (ICERs) are as follows:CN PMTCT vs. None PMTCT 2,189 yuan/QALYs; Delayed PMTCT vs. None PMTCT 1,274 yuan/QALYs; CN PMTCT vs. Delayed PMTCT 6,439 yuan /QALYs. PMTCT mainly influenced initial state distribution in our model. Compared with None PMTCT, CN PMTCT strategy prevented 72 HIV or AIDS infections. Even for Delayed PMTCT, a total of 57 HIV or AIDS infections were prevented. As for CN PMTCT, saving a HIV-free infant cost about 82,909 yuan for PMTCT intervention in contrast with None PMTCT. For Delayed PMTCT, it cost 50,160 yuan PMTCT for saving every HIV-free infant.2. Sensitivity analysis results show that as parameters changed, ICERs of CN PMTCT group vs. the other two groups are always less than a preset willingness to pay (WTP) threshold. Cost for saving each QALY declined as HIV prevalence among pregnant women increased. As cost for HIV infection and AIDS patients increased, CN PMTCT turned to be cost saving strategy as early investment can be offset by later saved expenditure.3. When number of trials is 100,000, Monte Carlo trials simulation shows that cost and effectiveness per capita for three strategies (CN PMTCT, Delayed PMTCT and None PMTCT) are 86.28 yuan/29.50QALYs,57.34 yuan/29.49 QALYs and 29.15 yuan/29.47QALYs. CERs are 2.93,1.94 and 0.99 respectively. Cost values for Delayed PMTCT and None PMTCT have greater variation than CN PMTCT. ICERs are:CN PMTCT vs. None PMTCT 1,991 yuan/QALYs; Delayed PMTCT vs. None PMTCT 1,210 yuan/QALYs; CN PMTCT vs. Delayed PMTCT 5,351 yuan/QALYs, which all less than WTP threshold.4. When number of samples is 1,000, Monte Carlo Probabilistic Sensitivity analysis indicated that cost and effectiveness per capita for three strategies (CN PMTCT, Delayed PMTCT and None PMTCT) are 101.34 yuan/29.57QALYs,76.77 yuan/29.56QALYs?174.79 yuan/29.55QALYs. Cost values for Delayed PMTCT and None PMTCT are right skewed distributed. Acceptability Curve presents that when WTP>4,000 yuan, CN PMTCT is the most effective option.ConclusionThis study assumed three PMTCT strategies and found CN PMTCT strategy was cost effective with affordable costs. We also proposed further expanding PMTCT project coverage. In covered regions, HIV education targeting pregnant women should be strengthened to improve HIV related knowledge level and urge them to get HIV testing as early as possible. We also advocated exploring more suitable education pattern targeting this group. |
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