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Expert Rev Pharmacoecon Outcomes Res. 2017 Oct;17(5):459-467. doi: 10.1080/14737167.2017.1364161. Epub 2017 Aug 11.

Evidence on the cost-effectiveness of lifelong antiretroviral therapy for prevention of mother-to-child transmission of HIV: implications for resource-limited countries in sub-Saharan Africa.

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a Manchester Centre for Health Economics , University of Manchester , Manchester , UK.
b Department of Pharmacy , University of Zambia , Lusaka , Zambia.
c Centre for Health Services and Policy Research , The University of British Columbia , Vancouver , Canada.
d Department of Pharmacology & Therapeutics , University of Namibia , Windhoek , Namibia.
e Drug Utilization Research Unit (DURU), Department of Pharmacy , Nelson Mandela Metropolitan University , Port Elizabeth , South Africa.
f Division of Clinical Pharmacology , Karolinska Institute , Stockholm , Sweden.
g Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK.
h Health Economics Centre , Liverpool University Management School , Liverpool , UK.


The 2016 World Health Organization (WHO) consolidated guideline recommends lifelong antiretroviral therapy (ART) for all HIV-infected pregnant and breastfeeding women for preventing mother-to-child HIV transmission (PMTCT). Ambiguity remains about the cost-effectiveness of this strategy in resource-limited developing countries. Areas covered: We reviewed model-based studies on the cost-effectiveness of lifelong ART (formerly Option B+) relative to previous WHO guidelines for PMTCT. Our search using PubMed, Medline and Google Scholar for articles on Option B+ resulted in the final inclusion of seven studies published between 2012 and 2016. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to assess the quality of reporting. Outcomes of interest, which included infant infections averted, maternal quality and length of life, and the Incremental Cost Effectiveness Ratio (ICER), were used in comparing cost-effectiveness. Expert commentary: Despite most model-based studies favouring lifelong ART (Option B+) in terms of its cost-effectiveness in comparison to Options A and B, inclusiveness of the evidence remains weak for generalization. This is largely because setting specificity for providing lifelong ART to all pregnant and breastfeeding women may differ significantly in each setting. Consequently, future cost-effectiveness studies should be robust, setting-specific, and endeavor to assess the willingness and ability to pay of each setting.


Cost-effectiveness; HIV; antiretroviral therapy; implications; modeling; mother-to-child transmission; option B+; resource-limited countries

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