Point-of-care CD4 testing to inform selection of antiretroviral medications in South African antenatal clinics: a cost-effectiveness analysis

dc.contributor.authorCiaranello, Andrea Len_ZA
dc.contributor.authorMyer, Landonen_ZA
dc.contributor.authorKelly, Kathleenen_ZA
dc.contributor.authorChristensen, Sarahen_ZA
dc.contributor.authorDaskilewicz, Kristenen_ZA
dc.contributor.authorDoherty, Katieen_ZA
dc.contributor.authorBekker, Linda-Gailen_ZA
dc.contributor.authorHou, Taigeen_ZA
dc.contributor.authorWood, Robinen_ZA
dc.contributor.authorFrancke, Jordan Aen_ZA
dc.date.accessioned2016-01-02T05:05:45Z
dc.date.available2016-01-02T05:05:45Z
dc.date.issued2015en_ZA
dc.description.abstractBACKGROUND: Many prevention of mother-to-child HIV transmission (PMTCT) programs currently prioritize antiretroviral therapy (ART) for women with advanced HIV. Point-of-care (POC) CD4 assays may expedite the selection of three-drug ART instead of zidovudine, but are costlier than traditional laboratory assays. METHODS: We used validated models of HIV infection to simulate pregnant, HIV-infected women (mean age 26 years, gestational age 26 weeks) in a general antenatal clinic in South Africa, and their infants. We examined two strategies for CD4 testing after HIV diagnosis: laboratory (test rate: 96%, result-return rate: 87%, cost: $14) and POC (test rate: 99%, result-return rate: 95%, cost: $26). We modeled South African PMTCT guidelines during the study period (WHO " Option A "): antenatal zidovudine (CD4 ≤350/μL) or ART (CD4>350/μL). Outcomes included MTCT risk at weaning (age 6 months), maternal and pediatric life expectancy (LE), maternal and pediatric lifetime healthcare costs (2013 USD), and cost-effectiveness ($/life-year saved). RESULTS: In the base case, laboratory led to projected MTCT risks of 5.7%, undiscounted pediatric LE of 53.2 years, and undiscounted PMTCT plus pediatric lifetime costs of $1,070/infant. POC led to lower modeled MTCT risk (5.3%), greater pediatric LE (53.4 years) and lower PMTCT plus pediatric lifetime costs ($1,040/infant). Maternal outcomes following laboratory were similar to POC (LE: 21.2 years; lifetime costs: $23,860/person). Compared to laboratory , POC improved clinical outcomes and reduced healthcare costs. CONCLUSIONS: In antenatal clinics implementing Option A , the higher initial cost of a one-time POC CD4 assay will be offset by cost-savings from prevention of pediatric HIV infection.en_ZA
dc.identifier.apacitationCiaranello, A. L., Myer, L., Kelly, K., Christensen, S., Daskilewicz, K., Doherty, K., ... Francke, J. A. (2015). Point-of-care CD4 testing to inform selection of antiretroviral medications in South African antenatal clinics: a cost-effectiveness analysis. <i>PLoS One</i>, http://hdl.handle.net/11427/16159en_ZA
dc.identifier.chicagocitationCiaranello, Andrea L, Landon Myer, Kathleen Kelly, Sarah Christensen, Kristen Daskilewicz, Katie Doherty, Linda-Gail Bekker, Taige Hou, Robin Wood, and Jordan A Francke "Point-of-care CD4 testing to inform selection of antiretroviral medications in South African antenatal clinics: a cost-effectiveness analysis." <i>PLoS One</i> (2015) http://hdl.handle.net/11427/16159en_ZA
dc.identifier.citationCiaranello, A. L., Myer, L., Kelly, K., Christensen, S., Daskilewicz, K., Doherty, K., ... & Wools-Kaloustian, K. (2014). Point-of-care CD4 testing to inform selection of antiretroviral medications in South African antenatal clinics: a cost-effectiveness analysis. PloS one, 10(3), e0117751. doi:10.1371/journal.pone.0117751en_ZA
dc.identifier.ris TY - Journal Article AU - Ciaranello, Andrea L AU - Myer, Landon AU - Kelly, Kathleen AU - Christensen, Sarah AU - Daskilewicz, Kristen AU - Doherty, Katie AU - Bekker, Linda-Gail AU - Hou, Taige AU - Wood, Robin AU - Francke, Jordan A AB - BACKGROUND: Many prevention of mother-to-child HIV transmission (PMTCT) programs currently prioritize antiretroviral therapy (ART) for women with advanced HIV. Point-of-care (POC) CD4 assays may expedite the selection of three-drug ART instead of zidovudine, but are costlier than traditional laboratory assays. METHODS: We used validated models of HIV infection to simulate pregnant, HIV-infected women (mean age 26 years, gestational age 26 weeks) in a general antenatal clinic in South Africa, and their infants. We examined two strategies for CD4 testing after HIV diagnosis: laboratory (test rate: 96%, result-return rate: 87%, cost: $14) and POC (test rate: 99%, result-return rate: 95%, cost: $26). We modeled South African PMTCT guidelines during the study period (WHO " Option A "): antenatal zidovudine (CD4 ≤350/μL) or ART (CD4>350/μL). Outcomes included MTCT risk at weaning (age 6 months), maternal and pediatric life expectancy (LE), maternal and pediatric lifetime healthcare costs (2013 USD), and cost-effectiveness ($/life-year saved). RESULTS: In the base case, laboratory led to projected MTCT risks of 5.7%, undiscounted pediatric LE of 53.2 years, and undiscounted PMTCT plus pediatric lifetime costs of $1,070/infant. POC led to lower modeled MTCT risk (5.3%), greater pediatric LE (53.4 years) and lower PMTCT plus pediatric lifetime costs ($1,040/infant). Maternal outcomes following laboratory were similar to POC (LE: 21.2 years; lifetime costs: $23,860/person). Compared to laboratory , POC improved clinical outcomes and reduced healthcare costs. CONCLUSIONS: In antenatal clinics implementing Option A , the higher initial cost of a one-time POC CD4 assay will be offset by cost-savings from prevention of pediatric HIV infection. DA - 2015 DB - OpenUCT DO - 10.1371/journal.pone.0117751 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - Point-of-care CD4 testing to inform selection of antiretroviral medications in South African antenatal clinics: a cost-effectiveness analysis TI - Point-of-care CD4 testing to inform selection of antiretroviral medications in South African antenatal clinics: a cost-effectiveness analysis UR - http://hdl.handle.net/11427/16159 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16159
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0117751
dc.identifier.vancouvercitationCiaranello AL, Myer L, Kelly K, Christensen S, Daskilewicz K, Doherty K, et al. Point-of-care CD4 testing to inform selection of antiretroviral medications in South African antenatal clinics: a cost-effectiveness analysis. PLoS One. 2015; http://hdl.handle.net/11427/16159.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2015 Ciaranello et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherInfantsen_ZA
dc.subject.otherLife expectancyen_ZA
dc.subject.otherPediatricsen_ZA
dc.subject.otherAntenatal careen_ZA
dc.subject.otherHIV infectionsen_ZA
dc.subject.otherPediatric infectionsen_ZA
dc.subject.otherPregnancyen_ZA
dc.titlePoint-of-care CD4 testing to inform selection of antiretroviral medications in South African antenatal clinics: a cost-effectiveness analysisen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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