The costs and benefits of Option B+ for the prevention of mother-to-child transmission of HIV.

OBJECTIVE: Most countries follow WHO 2010 guidelines for the prevention of mother-to-child transmission (PMTCT) of HIV using either Option A or B for women not yet eligible for antiretroviral therapy (ART). Both of these approaches involve the use of antiretrovirals during pregnancy and breastfeeding. Some countries have adopted a new strategy Option B+ in which HIV-positive pregnant women are started immediately on ART and continued for life. Option B+ is more costly than Options A or B but provides additional health benefits. In this article we estimate the additional costs and effectiveness of Option B+. METHODS: We developed a deterministic model to simulate births breastfeeding and HIV infection in women in four countries Kenya Zambia South Africa and Vietnam that differ in fertility rate birth interval age at first birth and breastfeeding patterns but have similar age at HIV infection. We estimated the total PMTCT costs and new child infections under Options A B and B+ and measured cost-effectiveness as the incremental PMTCT-related costs per child infection averted. We included adult sexual transmissions averted from ART the corresponding costs saved and estimated the total incremental cost per transmission (child and adult) averted. RESULTS: When considering PMTCT-related costs and child infections Option B+ was the most cost-effective strategy costing between $6000 and $23 000 per infection averted compared with Option A. Option B+ averted more child infections compared with Option B in all four countries and cost less than Option B in Kenya and Zambia. When including adult sexual transmissions averted Option B+ cost less and averted more infections than Options A and B.