Health Economic Evaluation On Prevention And Control Program Of Mother-to-Child HIV Transmission

Objective: By establishing health economics evaluation system, evaluate the prevention and control program of mother-to-child HIV transmission(MTCT) in Shenzhen city. It can provide scientific basis for helping managers making health policy, guiding the future'better implementation of the program and optimized, reasonable resources allocation to compare the two different cases between implementation and non implementation.Methods: According to the monitoring and follow-up data from the program, estimated the total cost, and obtained the financial burden to disease by the investigation for AIDS patients. Calculated the total number of infections, economic burden avoided from the program and obtained quality-adjusted life years(QALYs); The program was estimated by means of health economics methods including cost-effectiveness, cost-benefit and cost-utility analysis.Results: 1 200 748 pregnant women were screened for HIV since the investigation of the program. 151 pregnant women, a ratios of 12.58/100 000, were detected as positive, of whom 90 chosed to continue pregnancy. Of the 151 pregnant women'spouses, 108 received HIV screening and 43 spouses were detected as positive, a ratios of 39.81%. The total cost of the program was 13.5009 million yuan after discounting, of which 12.0309 million yuan was used to find HIV-positive pregnant women.65 cases of adults and 37 infants were to avoid infection, the cost-effectiveness ratio(CER) to 132 400 yuan/ case, and the cost of identifying one HIV-infected pregnant women was 79 700 yuan.The direct economic burden, indirect economic burden and intangible economic burden of each HIV infected adult was 214.5 thousand yuan, 1.0526 million yuan and 218.6 thousand yuan, but was 375.4 thousand yuan, 56.5 thousand yuan and 382.6 thousand yuan for each HIV infected infant.The total avoided economic burden contributed to the program was 126.707 yuan, including 27.8323 million yuan of direct economic burden, 70.5095 million yuan of indirect economic burden and 28.3652 million yuan of intangible economic burden.The net benefit was 113.2061 million yuan and the benefit-cost ratio(BCR) was 9.39. The total obtained QALYs from the program was 1950.69, each one of which cost 6900 yuan and the cost-utility ratio(CUR) was -4700 yuan/QALY.The sensitivity analysis showed that each case of infection avoided cost 147 700 yuan at most; BCR was at least 6.00; and CUR was up to 10 700 yuan/QALY. If the feeding pattern was breast feeding, CER was 133 700 yuan/case; BCR was 9.56; Obtained QALYs was 1747.65, each one of which cost 7100 yuan and CUR was -4000 yuan/QALY.Conclusions: 65 cases of adults and 37 infants were to avoid HIV infection, and the cost of per avoided case was between 1 time and 3 times per capita GDP; BCR was greater than 1; Each QALY cost less than 30 000 dollar, and CUR was less than 0, all of which suggested that the implementation of the program had economic value. The sensitivity analysis showed the results of the evaluation were stable and reliable. The results of economic evaluation of artificial feeding was better than breast feeding.