For peer review only Cost-effectiveness of a repeat HIV test in pregnancy in India Journal: BMJ Open Manuscript ID: bmjopen-2014-006718 Article Type: Research Date Submitted by the Author: 23-Sep-2014 Complete List of Authors: Joshi, Smita; Hirabai Cowasji Jehangir Medical Research Institute, Preventive Oncology Kulkarni, Vinay; Prayas, Gangakhedkar, Raman; National AIDS Research Institute, Mahajan, Uma; Hirabai Cowasji Jehangir Medical Research Institute, Shamra, Sushama; MIMER, Shirole, Devendra; Kamala Nehru Hospital, Chandhiok, Nomita; Indian Council of Medical Research, <b>Primary Subject Heading</b>: HIV/AIDS Secondary Subject Heading: Epidemiology, HIV/AIDS, Obstetrics and gynaecology Keywords: EPIDEMIOLOGY, HIV & AIDS < INFECTIOUS DISEASES, Public health < INFECTIOUS DISEASES For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open on December 14, 2020 by guest. Protected by copyright. http://bmjopen.bmj.com/ BMJ Open: first published as 10.1136/bmjopen-2014-006718 on 11 June 2015. Downloaded from
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BMJ Open · MTCT transmission rates are as low as 2% due to wide coverage and provision of highly effective anti-retroviral treatment (ART) regimen(2,3). In India, PMTCT program is
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For peer review only
Cost-effectiveness of a repeat HIV test in pregnancy in India
Journal: BMJ Open
Manuscript ID: bmjopen-2014-006718
Article Type: Research
Date Submitted by the Author: 23-Sep-2014
Complete List of Authors: Joshi, Smita; Hirabai Cowasji Jehangir Medical Research Institute, Preventive Oncology Kulkarni, Vinay; Prayas, Gangakhedkar, Raman; National AIDS Research Institute, Mahajan, Uma; Hirabai Cowasji Jehangir Medical Research Institute, Shamra, Sushama; MIMER, Shirole, Devendra; Kamala Nehru Hospital, Chandhiok, Nomita; Indian Council of Medical Research,
<b>Primary Subject Heading</b>:
HIV/AIDS
Secondary Subject Heading: Epidemiology, HIV/AIDS, Obstetrics and gynaecology
Keywords: EPIDEMIOLOGY, HIV & AIDS < INFECTIOUS DISEASES, Public health < INFECTIOUS DISEASES
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open on D
ecember 14, 2020 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2014-006718 on 11 June 2015. D
1. UNAIDS. Global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. 2011-2015. Accessed online at http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/20110609_jc2137_global-pla.
2. Mofenson LM. Successes and challenges in the perinatal HIV-1 epidemic in the United States as illustrated by the HIV-1 Serosurvey of childbearing women. Arch Pediatr Adolesc Med [Internet]. 2004 May [cited 2013 Jul 21];158(5):422–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15123471
3. Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy. European Collaborative Study. Clin Infect Dis [Internet]. 2005 Feb 1 [cited 2013 Jul 21];40(3):458–65. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15668871
4. India PMTCT Factsheet: UNICEF, accessed online at http://www.unicef.org/aids/files/IndiaFactsheet_PMTCTFactsheet_2010.pdf on 5th October 2013.
5. Factsheets on the status of national PMTCT responses in the most affected countries. The Interagency Task Team on the Prevention and Treatment of HIV Infection in Pregnant Women, Mothers and Children. [Internet]. [cited 2013 Aug 25]. Available from: http://www.emtct-iatt.org/countries/india/
6. NACO. Annual CMIS Bulletin 2008-09. NACO. Department of AIDS Control, Ministry of Health and Family Welfare, Govt of India. Accessed online at http://aidsdatahub.org/dmdocuments/NACO_Annual_CMIS_BULLETIN_2008-09.pdf on 5th October 2013.
7. National AIDS Control Organisation M of H& FWG of I. Antiretroviral Therapy Guidelines for HIV-Infected Adults and Adolescents Including Post-exposure Prophylaxis.
8. Garcia PM, Kalish LA, Pitt J, Minkoff H, Quinn TC, Burchett SK, et al. Maternal levels of plasma human immunodeficiency virus type 1 RNA and the risk of perinatal transmission. Women and Infants Transmission Study Group. N Engl J Med [Internet]. 1999 Aug 5 [cited 2013 Sep 6];341(6):394–402. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10432324
9. Lindbäck S, Karlsson AC, Mittler J, Blaxhult A, Carlsson M, Briheim G, et al. Viral dynamics in primary HIV-1 infection. Karolinska Institutet Primary HIV Infection Study Group. AIDS [Internet]. 2000 Oct 20 [cited 2013 Sep 6];14(15):2283–91. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11089616
10. Dunn DT, Newell ML, Ades AE, Peckham CS. Risk of human immunodeficiency virus type 1 transmission through breastfeeding. Lancet [Internet]. 1992 Sep 5 [cited 2013 Sep 6];340(8819):585–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/1355163
Page 13 of 23
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
11. Gray RH, Li X, Kigozi G, Serwadda D, Brahmbhatt H, Wabwire-Mangen F, et al. Increased risk of incident HIV during pregnancy in Rakai, Uganda: a prospective study. Lancet [Internet]. 2005 Oct 1 [cited 2013 Sep 6];366(9492):1182–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16198767
12. Cao Y, Krogstad P, Korber BT, Koup RA, Muldoon M, Macken C, et al. Maternal HIV-1 viral load and vertical transmission of infection: the Ariel Project for the prevention of HIV transmission from mother to infant. Nat Med [Internet]. 1997 May [cited 2013 Sep 6];3(5):549–52. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9142125
13. Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep [Internet]. 2006 Sep 22 [cited 2013 Jul 21];55(RR-14):1–17; quiz CE1–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16988643
14. Dandona L, Kumar SP, Ramesh Y, Rao MC, Kumar AA, Marseille E, et al. Changing cost of HIV interventions in the context of scaling-up in India. AIDS [Internet]. 2008 Jul [cited 2014 Apr 17];22 Suppl 1:S43–9. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3688470&tool=pmcentrez&rendertype=abstract
15. Venkatesh KK, Becker JE, Kumarasamy N, Nakamura YM, Mayer KH, Losina E, et al. Clinical impact and cost-effectiveness of expanded voluntary HIV testing in India. PLoS One [Internet]. 2013 Jan [cited 2014 Apr 17];8(5):e64604. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3669338&tool=pmcentrez&rendertype=abstract
16. Aledort JE, Ronald A, Le Blancq SM, Ridzon R, Landay A, Rafael ME, Shea MV, Safrit J, Peeling RW, Hellmann N, Mwaba P, Holmes K WC. Reducing the burden of HIV/AIDS in infants: the contribution of improved diagnostics. Nature 2006 Nov 23;444 Suppl 119-28.
17. WHO. Global Health Observatory (GHO). Country Statistics (India). [Internet]. World Health Organization; Available from: http://www.who.int/gho/countries/ind/en/
18. WHO. Use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants. World Health Organization; [cited 2014 Apr 17]; Available from: http://www.who.int/hiv/pub/mtct/programmatic_update2012/en/
19. Soorapanth S, Sansom S, Bulterys M, Besser M, Theron G, Fowler MG. Cost-effectiveness of HIV rescreening during late pregnancy to prevent mother-to-child HIV transmission in South Africa and other resource-limited settings. J Acquir Immune Defic Syndr [Internet]. 2006 Jun [cited 2013 Oct 6];42(2):213–21. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16639346
20. Sanders GD, Bayoumi AM, Sundaram V, Bilir SP, Neukermans CP, Rydzak CE, et al. Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy. N Engl J Med [Internet]. 2005 Feb 10 [cited 2014 Mar 24];352(6):570–85. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15703422
21. National AIDS Control Organisation. Annual Report 2012-13. Department of AIDS Control. Ministry of Health and Family Welfare. [Internet]. [cited 2014 Apr 18]. Available from:
Page 14 of 23
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
22. Gupte N, Sastry J, Brookmeyer R, Phadke MA, Bhosale RA, Bollinger RC. Declining HIV infection rates among recently married primigravid women in Pune, India. J Acquir Immune Defic Syndr [Internet]. 2007 Aug 15 [cited 2013 Oct 6];45(5):570–3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17577126
23. Gangakhedkar RR, Bentley ME, Divekar AD, Gadkari D, Mehendale SM, Shepherd ME, et al. Spread of HIV infection in married monogamous women in India. JAMA [Internet]. 1997 Dec 17 [cited 2014 Mar 2];278(23):2090–2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9403424
24. PMTCT Guidelines 2013 | Health Systems Trust. The South African Antiretroviral Treatment Guidelines 2013. PMTCT Guidelines: Revised March 2013. [Internet]. [cited 2014 Apr 18]. Available from: http://www.hst.org.za/publications/pmtct-guidelines-2013
25. Newell M-L, Coovadia H, Cortina-Borja M, Rollins N, Gaillard P, Dabis F. Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis. Lancet [Internet]. [cited 2014 Apr 17];364(9441):1236–43. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15464184
Page 15 of 23
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
Table 1: Input parameters for decision analysis model
Variable [Reference] Comment
Life expectancy in years Life expectancy of a healthy baby(17)
65
Life expectancy of an HIV positive baby with ART(16)
30
Life expectancy of an HIV positive baby without ART(25)
2
Probabilities
Probability of HIV incidence rate in pregnant women
0.0012 (95% CI 0.00032-0.00297)
Based on new HIV infections detected during second HIV test in our study
Probability of receiving ART to women detected with HIV in the second test
0.5 (95% CI 0.33-0.964)
Based on our study findings
Probability of breast feeding 1 Based on our study findings Cost (USD, 1 USD = INR 50) Cost of first HIV test(14), (15) USD 3.33
Cost of 2nd HIV test USD 0.6 (actual cost that was paid per test for the study)
Cost of ART for PMTCT(18) USD 178.75
Cost of HIV testing (HIV PCR) USD 16.0
Based on cost to Prayas’s EGPAF’s PMTCT programme
Cost of ART for HIV-infected baby(18)
USD 194.0
Quality Adjusted Life Years (QALY)
QALY of HIV un-infected baby(19),(20) 1 QALY of HIV-infected baby on ART(19), (20) 0.83 QALY of HIV positive baby without ART(19), (20) 0.73 QALY gained QALY gained* for healthy baby (HIV uninfected/ HIV negative baby)(17)
65
QALY gained for HIV positive baby on ART(20)
24.9
QALY gained for HIV positive baby without ART(20)
1.46
*QALY gained = QALY*Life expectancy
Page 16 of 23
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
on December 14, 2020 by guest. Protected by copyright. http://bmjopen.bmj.com/ BMJ Open: first published as 10.1136/bmjopen-2014-006718 on 11 June 2015. Downloaded from
Cost-effectiveness of a repeat HIV test in pregnancy in India
Journal: BMJ Open
Manuscript ID: bmjopen-2014-006718.R1
Article Type: Research
Date Submitted by the Author: 05-Mar-2015
Complete List of Authors: Joshi, Smita; Hirabai Cowasji Jehangir Medical Research Institute, Preventive Oncology Kulkarni, Vinay; Prayas, Gangakhedkar, Raman; National AIDS Research Institute, Mahajan, Uma; Hirabai Cowasji Jehangir Medical Research Institute, Shamra, Sushama; MIMER, Shirole, Devendra; Kamala Nehru Hospital, Chandhiok, Nomita; Indian Council of Medical Research,
<b>Primary Subject Heading</b>:
HIV/AIDS
Secondary Subject Heading: Epidemiology, HIV/AIDS, Obstetrics and gynaecology
Keywords: EPIDEMIOLOGY, HIV & AIDS < INFECTIOUS DISEASES, Public health < INFECTIOUS DISEASES
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
BMJ Open on D
ecember 14, 2020 by guest. P
rotected by copyright.http://bm
jopen.bmj.com
/B
MJ O
pen: first published as 10.1136/bmjopen-2014-006718 on 11 June 2015. D
Figure 1: Decision analysis model showing comparison of cost-effectiveness of proposed
strategy of repeat HIV testing of pregnant women in late pregnancy with the current strategy
of single HIV test
References:
1. UNAIDS. Global plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive. 2011-2015. Accessed online at http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/20110609_jc2137_global-pla.
2. Mofenson LM. Successes and challenges in the perinatal HIV-1 epidemic in the United States as illustrated by the HIV-1 Serosurvey of childbearing women. Arch Pediatr Adolesc Med [Internet]. 2004 May [cited 2013 Jul 21];158(5):422–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15123471
3. Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy. European Collaborative Study. Clin Infect Dis [Internet]. 2005 Feb 1 [cited 2013 Jul 21];40(3):458–65. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15668871
4. India PMTCT Factsheet: UNICEF, accessed online at http://www.unicef.org/aids/files/IndiaFactsheet_PMTCTFactsheet_2010.pdf on 5th October 2013.
5. Factsheets on the status of national PMTCT responses in the most affected countries. The Interagency Task Team on the Prevention and Treatment of HIV Infection in Pregnant Women, Mothers and Children. [Internet]. [cited 2013 Aug 25]. Available from: http://www.emtct-iatt.org/countries/india/
6. NACO. Annual CMIS Bulletin 2008-09. NACO. Department of AIDS Control, Ministry of Health and Family Welfare, Govt of India. Accessed online at http://aidsdatahub.org/dmdocuments/NACO_Annual_CMIS_BULLETIN_2008-09.pdf on 5th October 2013.
7. National AIDS Control Organisation M of H& FWG of I. Antiretroviral Therapy Guidelines for HIV-Infected Adults and Adolescents Including Post-exposure Prophylaxis.
8. Garcia PM, Kalish LA, Pitt J, Minkoff H, Quinn TC, Burchett SK, et al. Maternal levels of plasma human immunodeficiency virus type 1 RNA and the risk of perinatal transmission. Women and Infants Transmission Study Group. N Engl J Med [Internet]. 1999 Aug 5 [cited 2013 Sep 6];341(6):394–402. Available from: http://www.ncbi.nlm.nih.gov/pubmed/10432324
9. Lindbäck S, Karlsson AC, Mittler J, Blaxhult A, Carlsson M, Briheim G, et al. Viral dynamics in primary HIV-1 infection. Karolinska Institutet Primary HIV Infection Study Group. AIDS [Internet]. 2000 Oct 20 [cited 2013 Sep 6];14(15):2283–91. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11089616
Page 13 of 21
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
10. Dunn DT, Newell ML, Ades AE, Peckham CS. Risk of human immunodeficiency virus type 1 transmission through breastfeeding. Lancet [Internet]. 1992 Sep 5 [cited 2013 Sep 6];340(8819):585–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/1355163
11. Gray RH, Li X, Kigozi G, Serwadda D, Brahmbhatt H, Wabwire-Mangen F, et al. Increased risk of incident HIV during pregnancy in Rakai, Uganda: a prospective study. Lancet [Internet]. 2005 Oct 1 [cited 2013 Sep 6];366(9492):1182–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16198767
12. Cao Y, Krogstad P, Korber BT, Koup RA, Muldoon M, Macken C, et al. Maternal HIV-1 viral load and vertical transmission of infection: the Ariel Project for the prevention of HIV transmission from mother to infant. Nat Med [Internet]. 1997 May [cited 2013 Sep 6];3(5):549–52. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9142125
13. Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep [Internet]. 2006 Sep 22 [cited 2013 Jul 21];55(RR-14):1–17; quiz CE1–4. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16988643
14. Dandona L, Kumar SP, Ramesh Y, Rao MC, Kumar AA, Marseille E, et al. Changing cost of HIV interventions in the context of scaling-up in India. AIDS [Internet]. 2008 Jul [cited 2014 Apr 17];22 Suppl 1:S43–9. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3688470&tool=pmcentrez&rendertype=abstract
15. Venkatesh KK, Becker JE, Kumarasamy N, Nakamura YM, Mayer KH, Losina E, et al. Clinical impact and cost-effectiveness of expanded voluntary HIV testing in India. PLoS One [Internet]. 2013 Jan [cited 2014 Apr 17];8(5):e64604. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3669338&tool=pmcentrez&rendertype=abstract
16. Aledort JE, Ronald A, Le Blancq SM, Ridzon R, Landay A, Rafael ME, Shea MV, Safrit J, Peeling RW, Hellmann N, Mwaba P, Holmes K WC. Reducing the burden of HIV/AIDS in infants: the contribution of improved diagnostics. Nature 2006 Nov 23;444 Suppl 119-28.
17. WHO. Global Health Observatory (GHO). Country Statistics (India). [Internet]. World Health Organization; Available from: http://www.who.int/gho/countries/ind/en/
18. WHO. Use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants. World Health Organization; [cited 2014 Apr 17]; Available from: http://www.who.int/hiv/pub/mtct/programmatic_update2012/en/
19. Soorapanth S, Sansom S, Bulterys M, Besser M, Theron G, Fowler MG. Cost-effectiveness of HIV rescreening during late pregnancy to prevent mother-to-child HIV transmission in South Africa and other resource-limited settings. J Acquir Immune Defic Syndr [Internet]. 2006 Jun [cited 2013 Oct 6];42(2):213–21. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16639346
20. Sanders GD, Bayoumi AM, Sundaram V, Bilir SP, Neukermans CP, Rydzak CE, et al. Cost-effectiveness of screening for HIV in the era of highly active antiretroviral
Page 14 of 21
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
therapy. N Engl J Med [Internet]. 2005 Feb 10 [cited 2014 Mar 24];352(6):570–85. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15703422
21. National AIDS Control Organisation. Annual Report 2012-13. Department of AIDS Control. Ministry of Health and Family Welfare. [Internet]. [cited 2014 Apr 18]. Available from: http://www.naco.gov.in/NACO/Quick_Links/Publication/Annual_Report/NACO_Annual_Report/Annual_Report_2012-13/
22. 2012. A online at http://www. who. int/gho/map_gallery/en. on 18th D. WHO | Map gallery. World Health Organization; [cited 2012 Dec 18]; Available from: http://www.who.int/gho/map_gallery/en/
23. Gupte N, Sastry J, Brookmeyer R, Phadke MA, Bhosale RA, Bollinger RC. Declining HIV infection rates among recently married primigravid women in Pune, India. J Acquir Immune Defic Syndr [Internet]. 2007 Aug 15 [cited 2013 Oct 6];45(5):570–3. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17577126
24. Kulkarni V, Joshi S, Gupte N, Parchure R, Darak S, Kulkarni S. Declining HIV prevalence among women attending antenatal care in Pune, India. Trans R Soc Trop Med Hyg [Internet]. 2011 Jun [cited 2013 Oct 6];105(6):315–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21550094
25. Gangakhedkar RR, Bentley ME, Divekar AD, Gadkari D, Mehendale SM, Shepherd ME, et al. Spread of HIV infection in married monogamous women in India. JAMA [Internet]. 1997 Dec 17 [cited 2014 Mar 2];278(23):2090–2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9403424
26. PMTCT Guidelines 2013 | Health Systems Trust. The South African Antiretroviral Treatment Guidelines 2013. PMTCT Guidelines: Revised March 2013. [Internet]. [cited 2014 Apr 18]. Available from: http://www.hst.org.za/publications/pmtct-guidelines-2013
27. Newell M-L, Coovadia H, Cortina-Borja M, Rollins N, Gaillard P, Dabis F. Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis. Lancet [Internet]. Jan [cited 2014 Apr 17];364(9441):1236–43. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15464184
Page 15 of 21
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
Table 1: Input parameters for decision analysis model
Variable [Reference] Comment
Life expectancy in years Life expectancy of a healthy baby(17)
65
Life expectancy of an HIV positive baby with ART(16)
30
Life expectancy of an HIV positive baby without ART(27)
2
Probabilities
Probability of HIV incidence rate in pregnant women
0.0012 (95% CI 0.00032-0.00297)
Based on new HIV infections detected during second HIV test in our study
Probability of receiving ART to women detected with HIV in the second test
0.5 (95% CI 0.33-0.964)
Based on our study findings
Probability of breast feeding 1 Based on our study findings Cost (USD, 1 USD = INR 50) Cost of first HIV test(14), (15) USD 3.33
Cost of 2nd HIV test(14), (15) USD 3.33
Cost of ART for PMTCT(18) USD 178.75
Cost of HIV testing (HIV PCR) USD 16.0
Based on cost to Prayas’s EGPAF’s PMTCT programme
Cost of ART for HIV-infected baby(18)
USD 194.0
Quality Adjusted Life Years (QALY)
QALY of HIV un-infected baby(19),(20) 1 QALY of HIV-infected baby on ART(19), (20) 0.83 QALY of HIV positive baby without ART(19), (20) 0.73 QALY gained QALY gained* for healthy baby (HIV uninfected/ HIV negative baby)(17)
65
QALY gained for HIV positive baby on ART(20)
24.9
QALY gained for HIV positive baby without ART(20)
1.46
*QALY gained = QALY*Life expectancy
Page 16 of 21
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml
Figure 1: Decision analysis model showing comparison of cost-effectiveness of proposed strategy of repeat HIV testing of pregnant women in late pregnancy with the current strategy of single HIV test
88x30mm (300 x 300 DPI)
Page 19 of 21
For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml