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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
The cost-effectiveness of cotrimoxazole prophylaxis in HIV-infected children in Zambia
AIDS, Volume 22, No. 6, Year 2008
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Description
OBJECTIVE: To assess the cost-effectiveness of cotrimoxazole prophylaxis in HIV-infected children in Zambia, as implementation at the local health centre level has yet to be undertaken in many resource-limited countries despite recommendations in recent updated World Health Organization (WHO) guidelines. DESIGN: A probabilistic decision analytical model of HIV/AIDS progression in children based on the CD4 cell percentage (CD4%) was populated with data from the placebo-controlled Children with HIV Antibiotic Prophylaxis trial that had reported a 43% reduction in mortality with cotrimoxazole prophylaxis in HIV-infected children aged 1-14 years. METHODS: Unit costs (US$ in 2006) were measured at University Teaching Hospital, Lusaka. Cost-effectiveness expressed as cost per life-year saved, cost per quality adjusted life-year (QALY) saved, cost per disability adjusted life-year (DALY) averted was calculated across a number of different scenarios at tertiary and primary healthcare centres. RESULTS: Cotrimoxazole prophylaxis was associated with incremental cost-effectiveness ratios (ICERs) of US$72 per life-year saved, US$94 per QALY saved and US$53 per DALY averted, i.e. substantially less than a cost-effectiveness threshold of US$1019 per outcome (gross domestic product per capita, Zambia 2006). ICERs of US$5 or less per outcome demonstrate that cotrimoxazole prophylaxis is even more cost-effective at the local healthcare level. The intervention remained cost-effective in all sensitivity analyses including routine haematological and CD4% monitoring, varying starting age, AIDS status, cotrimoxazole formulation, efficacy duration and discount rates. CONCLUSION: Cotrimoxazole prophylaxis in HIV-infected children is an inexpensive low technology intervention that is highly cost-effective in Zambia, strongly supporting the adoption of WHO guidelines into essential healthcare packages in low-income countries. © 2008 Lippincott Williams & Wilkins, Inc.
Authors & Co-Authors
Ryan, Máirín A.A.
Ireland, Dublin
Trinity College Dublin
Ireland, Dublin
St James's Hospital
Griffin, Susan C.
United Kingdom, York
University of York
Chitah, Bona Mukosha
Zambia, Lusaka
Zambian Ministry of Health
Walker, A. Sarah
United Kingdom, London
Medical Research Council
Mulenga, Veronica
Zambia, Lusaka
University Teaching Hospital Lusaka
Kalolo, Donald
Zambia, Lusaka
University Teaching Hospital Lusaka
Hawkins, Neil Stephen
United Kingdom, York
University of York
Merry, Concepta
Ireland, Dublin
Trinity College Dublin
Barry, Michael G.
Ireland, Dublin
Trinity College Dublin
Chintu, Chifumbe Z.
Zambia, Lusaka
University Teaching Hospital Lusaka
Sculpher, Mark John S.
United Kingdom, York
University of York
Gibb, Diana M.
United Kingdom, London
Medical Research Council
Statistics
Citations: 50
Authors: 12
Affiliations: 6
Identifiers
Doi:
10.1097/QAD.0b013e3282f43519
Research Areas
Disability
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Randomised Control Trial
Study Locations
Zambia