Cost-effectiveness of integrated maternal HIV, syphilis, and hepatitis B screening opt-out strategies in Nepal: a modelling study

IF 5 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet regional health. Southeast Asia Pub Date : 2025-01-01 DOI:10.1016/j.lansea.2024.100524

Lucie Sabin , Kasim Allel , Ghanshyam Gautam , Naomi Saville , Hassan Haghparast-Bidgoli

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引用次数: 0

Abstract

Background

The World Health Organisation (WHO) developed a comprehensive framework encouraging an integrated approach to achieve triple elimination of vertical transmission of HIV, syphilis, and hepatitis B in Asia. Current screening practices in Nepal show significantly lower coverage for syphilis and hepatitis B compared to HIV suggesting potential for integration. In this study, we aimed to model the cost-effectiveness of triple screening during antenatal care in Nepal.

Methods

We modelled maternal HIV, hepatitis B, and syphilis cascade of care and their corresponding disease states using disease-specific Markov models over a 20-year horizon with a cycle length of one year. We compared dual integrated screening for HIV and syphilis and triple integrated screening for HIV, syphilis, and hepatitis B with HIV screening only. Costs were estimated from a provider's perspective. Results were presented as incremental cost-effectiveness ratios (ICERs). Univariable and probabilistic sensitivity analyses were conducted.

Findings

Our modelling analysis showed that dual-integrated screening for HIV and syphilis was highly cost-effective when compared to current strategy of screening for HIV only (ICERs of US$18). Triple-integrated antenatal screening for HIV, syphilis, and hepatitis B was highly cost-effective compared with dual-integrated strategy with an ICER of US$114. Moreover, 100% and 98% of the probabilistic sensitivity analysis estimates for dual- and triple-integrated screening were proven cost-effective, compared to HIV-only screening.

Interpretation

Our results support WHO recommendations for implementing integrated triple antenatal screening in Nepal and Asia more broadly, aiming to reduce maternal and neonatal morbidity through early detection and intervention.

Funding

No funding was reported.

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尼泊尔孕产妇艾滋病毒、梅毒和乙肝筛查选择退出策略的成本效益：一项模型研究。

背景：世界卫生组织（WHO）制定了一个综合框架，鼓励采用综合方法在亚洲消除艾滋病毒、梅毒和乙型肝炎的三重垂直传播。尼泊尔目前的筛查实践表明，梅毒和乙型肝炎的筛查覆盖率明显低于艾滋病，这表明有可能进行整合。在这项研究中，我们旨在模拟尼泊尔产前护理期间三重筛查的成本效益：方法：我们使用特定疾病马尔可夫模型，模拟了为期 20 年、周期长度为一年的孕产妇艾滋病、乙型肝炎和梅毒级联护理及其相应的疾病状态。我们比较了 HIV 和梅毒双重综合筛查、HIV、梅毒和乙肝三重综合筛查与仅 HIV 筛查。我们从提供者的角度估算了成本。结果以增量成本效益比（ICER）表示。我们还进行了单变量和概率敏感性分析：我们的建模分析表明，与目前仅筛查 HIV 的策略相比，HIV 和梅毒的双重综合筛查具有很高的成本效益（ICER 为 18 美元）。艾滋病、梅毒和乙型肝炎三联产前筛查与双联策略相比具有很高的成本效益，ICER 为 114 美元。此外，与单纯的艾滋病筛查相比，100% 和 98% 的概率敏感性分析估计值证明双重和三重整合筛查具有成本效益：我们的研究结果支持世界卫生组织的建议，即在尼泊尔和亚洲更广泛地实施综合三联产前筛查，旨在通过早期发现和干预降低孕产妇和新生儿发病率：未报告资金来源。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

The Lancet regional health. Southeast Asia

CiteScore

2.20

自引率

0.00%

发文量