National and provincial estimated costs and cost effectiveness of a programme to reduce mother-to-child HIV transmission in South Africa

Objective. To estimate the cost and cost effectiveness nationally and for e ach province of a programme to reduce mother-to-child transmission (MTCT) o f HIV in South Africa. Methods. A model developed to estimate cost and cost effectiveness of inter ventions in Hlabisa, KwaZulu-Natal, was modified and applied to each provin ce. This model predicts a 37% reduction in paediatric HIV infections if sho rt-course oral zidovudine (ZDV) plus infant formula feed for 4 months is pr ovided within a strengthened health system. Estimates of the number of preg nancies and HIV prevalence among pregnant women per province in 1997 were c ombined with an estimated 30% MTCT rate. Costs were calculated from a healt h system perspective, and effectiveness was estimated as cost per infection averted and cost per disability-adjusted life year (DALY) gained. Results. In 1997, 63 397 paediatric HIV infections were estimated to have o ccurred in South Africa, mainly in KwaZulu-Natal (18 513, 29%) and Gauteng (10 417, 16%). The cost of a national programme is estimated at R155.9 mill ion (1997 rand costs, 0.94% of the national health budget). Major cost item s are drugs (R46.4m, 30%), staff salaries (R45.8m, 29%), and formula feed ( R37.1m, 24%). Most money would need to be spent in KwaZulu-Natal (R37.6m, 2 4% of national cost), Gauteng (R25.2m, 16%) and the Eastern Cape (R24m, 15% ). National cost per infection averted is R6 724, and R213 per DALY gained. Provincial DALY costs range from R176 to R369. Conclusions. A national programme preventing 37% of expected paediatric HIV infections would cost a small fraction of the national health budget, at a cost equivalent to R3.89 per capita total population. The cost per DALY ga ined compares well with established public health and clinical intervention s in middle-income countries, even without factoring in the care costs that would be saved through a successful programme. Cost effectiveness is great est where HN prevalence is highest.