Health Economics

Health economic analysis led by the Infectious Diseases Institute will examine costs, and cost-effectiveness of dolutegravir, using published vertical transmission prevention cost-effectiveness models established for WHO Option B/B+ prevention programmes, with the aim of facilitating the incorporation of DTG into treatment guidelines post-trial.  The main aim of this output is to assess the pharmacoeconomic outcome of preventing vertical transmission with DTG.

Using decision-based analytical models and a national health systems perspective, the following will be evaluated: (i) the cost-effectiveness of increasing access to DTG-based cART for preventing vertical transmission among women without access due to lack of drugs, lack of local health-care centres or lack of knowledge of HIV infection (ii) the cost-effectiveness of life-long DTG vs EFV-based cART. Overhead costs to overcome barriers to access to prevent vertical transmission will be obtained from previously published analyses.   The probability of vertical transmission will be obtained from the clinical trial results of DolPHIN-2 with VL used as a proxy for preventing vertical transmission.  Estimates of the disability-adjusted life years (DALYs) associated with vertical transmission will be based on the HIV-attributable reduction in life expectancy plus standard disability weights for HIV infection and AIDS. Based on the differences in the probability of vertical transmission with each treatment alternative, the treatment-related costs offsets arising from the need to provide health care services to fewer HIV positive infants in the future will be calculated. For example, for each child requiring ART in Uganda, the discounted lifetime cost of ART is ~$3800, with a mean life expectancy of around 15 years. Based on the discounted differences in life expectancy between HIV-negative children and HIV-positive children who are left untreated, or given ART, a child infection can be estimated to be associated with 23.70 DALYs. Cost effectiveness analysis will yield the incremental costs per DALY averted using DTG-based ART versus standard of care. The cost-effectiveness of expanding access will be subjected to break-even analysis.