Abstract
Objective: The purpose of this study is to investigate the most cost effective strategy for the Prevention of HIV Mother-to-Child Transmission (PMCT) in Japan.
Methods: A comprehensive computer simulation method with Microsoft Excel 2000 was used in this study. We selected the four well-known PMCT protocols; 1) ACTG076, 2) ACTG076+Elective Caesarian Section (C/S), 3) Elective C/S only, and 4) HIVENT012. The total PMCT cost was defined as the sum of the indirect prevention costs like regular antenatal (or prenatal) check ups and direct prevention costs including maternal HIV test, labor expenses, medication fees, baby formula, PCR tests and C/S expenses. “No prevention strategy” was also simulated as a control. Every cost was calculated based on the national health insurance credits. Each vertical transmission rate was quoted from past large-scale studies. The effectiveness of every prevention strategy was evaluated with both the expected number of non-infected infants through each strategy and its total PMCT cost. The reported current HIV prevalence rate among pregnant women in Japan is about 0.02% ; however, we also investigated on the assumption that will be from 0.005% to 1.0% respectively to simulate future HIV prevalence situations in Japan.
Results: When the HIV prevalence rate surpassed 0.02%, “ACTG076+elective C/S” showed the most cost effective result, on the condition that the life-long medication cost per one HIV-infected child is 75 million yen (equal to nearly US$630, 000). When the prevalence rate was 0.02 %and below, however, there were no significant difference among strategies.
Conclusion: “ACTG076 + elective C/S” will be the most cost-effective and morally acceptable strategy to cope with the prospective increase of HIV-positive pregnancy in Japan in the future as well as in the current situation.
