Estimated costs for the delivery of safer conception strategies for HIV-discordant couples in Zimbabwe: a cost analysis

• Published in: BMC health services research 2020-10, Vol.20 (1), p.940-940, Article 940
• Main Authors: Hughes, Carolyn Smith, Brown, Joelle, Murombedzi, Caroline, Chirenda, Thandiwe, Chareka, Gift, Mhlanga, Felix, Mateveke, Bismark, Gitome, Serah, Makurumure, Tinei, Matubu, Allen, Mgodi, Nyaradzo, Chirenje, Zvavahera, Kahn, James G
• Format: Article
• Language: English
• Subjects: Adult; Anti-HIV Agents - economics; Anti-HIV Agents - therapeutic use; Antiretroviral drugs; Care and treatment; Child care; Clinical trials; Conception; Contraception - adverse effects; Contraception - economics; Contraception - methods; Cost; Cost benefit analysis; Costs; Counseling; Couples; Delivery (Childbirth); Disease prevention; Family Characteristics; Female; Health care costs; Health services; HIV; HIV infections; HIV Infections - epidemiology; HIV Infections - prevention & control; HIV patients; HIV Seronegativity; HIV Seropositivity; Human immunodeficiency virus; Humans; Laboratories; Male; Measurement; Medical tests; Methods; Middle Aged; Ovulation; Pre-Exposure Prophylaxis - economics; PrEP; Prevention; Semen - virology; Semen-washing; Young Adult; Zimbabwe - epidemiology
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-020-05784-4

In recent years, safer conception strategies have been developed to help HIV-serodiscordant couples conceive a child without transmitting HIV to the seronegative partner. The SAFER clinical trial assessed implementation of these strategies in Zimbabwe. As a part of the SAFER study, we estimated the costs (in 2017 $US) associated with individual and combination strategies, in the trial setting and real-world practice, from a healthcare system perspective. Safer conception strategies included: 1) ART with frequent viral load testing until achieving undetectable viral load (ART-VL); 2) daily oral pre-exposure prophylaxis (PrEP); 3) semen-washing with intrauterine insemination; and 4) manual self-insemination at home. For costs in the trial, we used a micro-costing approach, including a time and motion study to quantify personnel effort, and estimated the cost per couple for individual and combination strategies for a mean of 6 months of safer services. For real-world practice, we modeled costs for three implementation scenarios, representing differences from the trial in input prices (paid by the Ministry of Health and Child Care [MOHCC]), intervention intensity, and increments to current HIV prevention and treatment practices and guidelines. We used one-way sensitivity analyses to assess the impact of uncertainty in input variables. Individual strategy costs were $769-$1615 per couple in the trial; $185-$563 if using MOHCC prices. Under the target intervention intensity and using MOHCC prices, individual strategy costs were $73-$360 per couple over and above the cost of current HIV clinical practices. The cost of delivering the most commonly selected combination, ART-VL plus PrEP, ranged from $166-$517 per couple under the three real-world scenarios. Highest costs were for personnel, lab tests, and strategy-specific consumables, in variable proportions by clinical strategy and analysis scenario. Total costs were most affected by uncertainty in the price of PrEP, number of semen-washing attempts, and scale-up of semen-washing capacity. Safer conception methods have costs that may be affordable in many low-resource settings. These cost data will help implementers and policymakers add safer conception services. Cost-effectiveness analysis is needed to assess value for money for safer conception services overall and for safer strategy combinations. Registry Name: Clinicaltrials.gov. NCT03049176 . Registration date: February 9, 2017.