COST-EFFECTIVENESS OF SHORT-COURSE ZIDOVUDINE TO PREVENT PERINATAL HIV TYPE-1 INFECTION IN A SUB-SAHARAN AFRICAN DEVELOPING-COUNTRY SETTING

Objective.-To evaluate the cost-effectiveness of a short-course zidovu dine program to prevent perinatal transmission of human immunodeficien cy virus (HIV) type 1 in sub-Saharan African country settings. Design and Setting.-Several clinical trials of short-course zidovudine during pregnancy for prevention of perinatal transmission of HIV are under w ay in developing countries in sub-Saharan Africa. A decision model was used to examine the cost-effectiveness of zidovudine programs in a hy pothetical 1-year birth cohort in a sub-Saharan African setting from t he perspective of the health care system and of society. A completed s hort course of zidovudine was assumed to reduce perinatal HIV transmis sion from 25% to 16.5%, approximately one half of the effect of the lo nger-course zidovudine. Estimates of program costs, lifetime HIV-relat ed health care costs, and lost productivity costs were derived from th e published literature and from preliminary data available from sites of planned clinical trials. Sensitivity analyses were conducted on all relevant parameters. Main Outcome Measures.-Medical costs, lost produ ctivity costs, program costs, cost savings, and incremental cost-effec tiveness, expressed as cost per infant HIV infection prevented. Result s.-The model estimated that a national zidovudine program in a setting with 12.5% HIV seroprevalence would reduce perinatal HIV incidence by 12% (4.9 infections per 1000 births), The cost to the health care sys tem would be $3748 per infant HIV infection prevented. When productivi ty losses were included in the model, the cost decreases to $1115 per infant HIV infection prevented. The cost to implement a national zidov udine program including the cost of counseling, testing, and drugs, wo uld be $2 million per 100 000 births or $20 per pregnant woman. In the base case, decreases in the cost of counseling and testing and increa ses in maternal HIV prevalence, zidovudine efficacy, and medical and l ost productivity costs improved cost-effectiveness of the zidovudine p rogram. Conclusions.-Assuming demonstrable efficacy of short-course zi dovudine prevention of perinatal HIV, a national perinatal HIV prevent ion program with zidovudine in most sub-Saharan African country settin gs would reduce the incidence of infant HIV infection and, in some set tings, provide societal savings; however, substantial initial investme nt in such programs will be required. Where health care resources are limited, as in these regions, allocation of resources to a perinatal z idovudine program will need to be considered in the context of resourc es required for other pressing medical care needs.