| IntroductionThe rate of mother-to-child transmission of HIV-1(MTCT)range from 14%to 48%in the absence of any intervention,and this rate can be reduced to less than 2%with effective interventions during the periods of pregnancy,delivery and breastfeeding,while in 2017,the rate was 4.9%in China.Over several years,the number of HIV-positive pregnant women in Liangshan prefecture of Sichuan province accounts for about 10%of Chinese,and the rate of MTCT of HIV in Liangshan prefecture sustained higher than national average.Liangshan prefecture has become the key and difficult point for preventing mother-to-child transmission(PMTCT)of HIV in China.The Chinese government has invested a lot of money and human resource for PMTCT of HIV in Liangshan prefecture.But no research on cost-effectiveness of PMTCT of HIV in Liangshan Prefecture was sought out online literatures.Cost-effectiveness of PMTCT of HIV in Liangshan Prefecture was analyzed for providing suggestion for rational allocation and utilization of fund.Objective1.To analyze the source,traceability,and behavior of the cost of PMTCT of HIV program in Liangshan Prefecture.2.To analyze the efficacy,benefit,and utility of PMTCT of HIV program in Liangshan Prefecture and to evaluate the quality of life of HIV-positive pregnant women.3.To analyze the cost-effectiveness,cost-benefit,and cost-utility of PMTCT of HIV program in Liangshan Prefecture.4.To analyze the factors influencing the budget for PMTCT of HIV program in Liangshan Prefecture.Methods1.The prevalence study.We selected two counties each of high,medium,and low HIV prevalence in Liangshan Prefecture and investigated the maternal and child health care hospitals,Center for Disease Control and Prevention(briefly as CDC),and the People's Hospital in these counties.HIV-positive and HIV-negative pregnant women were recruited from high-prevalence counties to collect information on the cost,health services,and personal circumstances.We also assessed the health conditions of these pregnant women using the EQ-5D questionnaire.2.The model study.We analyzed the cost-effectiveness,cost-benefit,and cost-utility by constructing a decision tree and Markov model.3.Document research.We obtained some parameters of the models from the literature.4.Human capital approach.We measured the labor-value created by avoiding HIV infection in children,using the human capital approach.Results1.The cost analysisThe cost of PMTCT of HIV in the six counties was a total of 7.7044 million yuan in 2017.The expenditures were mainly from the central fiscal(63.45%),personal(18.26%),institutional(11.96%),county fiscal(4.47%),non-governmental organization(1.62%),state fiscal(0.13%)and provincial fiscal(0.11%)expenditure accounts.In cost traceability,direct medical,direct non-medical,and indirect costs were 47.50%,46.80%,and 5.70%,respectively.In the cost behavior,the variable and fixed costs were 76.22%and 23.78%,respectively.2.The basic situation and health utility of pregnant womenWe investigated 250 pregnant women in the study,all of whom were of the Yi ethnic group.HIV was tested positive in 117 women and negative in 133.The median health utility score of HIV-positive pregnant women was 0.961 while that of HIV-negative pregnant women was 0.875.The EQ-5D-3L showed significant differences(P=0.002)in anxiety and depression between the two groups.3.The prevalence study on cost-effectiveness of PMTCT in Liangshan PrefectureIn the six counties,34,991 pregnant women were screened for HIV;of them,456 tested positive.The unit cost of screening was 23.52 yuan.The unit cost of finding a positive case was 2002.64 yuan.The number of children who did not have an infection was 164.The cost of preventing a new infection was about 47.00 thousand yuan.4.The cost-effectiveness analysisIt is assumed that there is a cohort of 100,000 pregnant women,and the rate of HIV-positive occurrence is 1.92%,the number of children who would not get infection in delayed PMTCT,early-pregnancy PMTCT,and standard PMTCT are 561,583,and 633,respectively,and the cost of preventing an HIV infection in children is 22,300,30,300,and 33,500 yuan,respectively.Compared to delayed PMTCT,the incremental cost effectiveness ratios(ICERs)for early pregnancy PMTCT and standard PMTCT are 23,700 yuan and 120,100 yuan,respectively.The sensitivity analysis showed that the results are sensitive to low values of milk powder subsidy,unit price of screening reagents,and cost of early diagnosis of HIV-exposed infants.The cost-effectiveness of the three strategies and cost of preventing an HIV infection in children declined as HIV prevalence among pregnant women increased.When the HIV prevalence among pregnant women is between 0.09%and 0.39%,the cost-effectiveness of the three strategies are 46,600 to 27,000,53,700 to 34,800,and 55,000 to 37,600 yuan,respectively.4.The cost-utility analysisThe benefit-to-cost ratio for delayed PMTCT,early pregnancy PMTCT,standard PMTCT,and the current situation in Liangshan Prefecture are 4.11,2.76,2.40,and 1.46,respectively.Compared to the current situation in Liangshan Prefecture,the ICERs for delayed PMTCT,early pregnancy PMTCT,and standard PMTCT are 8.33,3.77,and 2.94,respectively.5.The analysis of factors influencing the budgetAccording to the current PMTCT of HIV program in China,the total budget of PMTCT in the six counties in Liangshan Prefecture is 5,144,500 yuan,including the private and fixed costs are 594,900 yuan and 280,900 yuan,respectively.Conclusions1.The PMTCT of HIV program in Liangshan Prefecture has good cost-effectiveness.However,the cost of preventing an HIV infection in children is higher in Liangshan Prefecture than strategies of delayed PMTCT,early pregnancy PMTCT,and standard PMTCT.Cost-effectiveness ratio and B/C of delayed PMTCT is better than strategies of early pregnancy PMTCT and standard PMTCT,and the NP and CUR of standard PMTCT is better than strategies of delayed PMTCT and early pregnancy PMTCT.2.There are a great many of HIV-positive pregnant women who receiving PMTCT services in the perinatal or postnatal period.3.The health condition of HIV-positive pregnant women was generally well.However,the health utility score was lower than that of HIV-negative pregnant women.4.The cost of CD4/VL detection reagents was lower than the standard PMTCT required.The private cost covered a definite proportion of the budget. |
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