Cost-effectiveness of broadly neutralizing antibodies for infant HIV prophylaxis in settings with high HIV burdens: a simulation modeling study

ABSTRACTIntroductionApproximately 130 000 infants acquire HIV annually despite global maternal antiretroviral therapy scale-up. We evaluated the potential clinical impact and cost-effectiveness of offering long-acting, anti-HIV broadly neutralizing antibody (bNAb) prophylaxis to infants in three dis...

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Bibliographic Details
Published in:BMC primary care 2023-11, Vol.23 (1)
Main Authors: Alba, Christopher, Malhotra, Shelly, Horsfall, Stephanie, Barnhart, Matthew E, Bekker, Adrie, Chapman, Katerina, Cunningham, Coleen K, Fast, Patricia E, Fouda, Genevieve G, Freedberg, Kenneth A, Goga, Ameena, Ghazaryan, Lusine R, Leroy, Valériane, Mann, Carlyn, Mccluskey, Margaret M, Mcfarland, Elizabeth J, Muturi-Kioi, Vincent, Permar, Sallie R, Shapiro, Roger, Sok, Devin, Stranix-Chibanda, Lynda, Weinstein, Milton C, Ciaranello, Andrea L, Dugdale, Caitlin M
Format: Article
Language:English
Subjects:
Life Sciences
Santé publique et épidémiologie
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Summary:ABSTRACTIntroductionApproximately 130 000 infants acquire HIV annually despite global maternal antiretroviral therapy scale-up. We evaluated the potential clinical impact and cost-effectiveness of offering long-acting, anti-HIV broadly neutralizing antibody (bNAb) prophylaxis to infants in three distinct settings.MethodsWe simulated infants in Côte d’Ivoire, South Africa, and Zimbabwe using the Cost-Effectiveness of Preventing AIDS Complications-Pediatric (CEPAC-P) model. We modeled strategies offering a three-bNAb combination in addition to WHO-recommended standard-of-care oral prophylaxis to infants: a) with known, WHO-defined high-risk HIV exposure at birth (HR-HIVE); b) with known HIV exposure at birth (HIVE); or c) with or without known HIV exposure (ALL). Modeled infants received1-dose,2-doses, orExtended(every 3 months through 18 months) bNAb dosing. Base case model inputs included 70% bNAb efficacy (sensitivity analysis range: 10-100%), 3-month efficacy duration/dosing interval (1-6 months), and $20/dose cost ($5-$100/dose). Outcomes included pediatric HIV infections, life expectancy, lifetime HIV-related costs, and incremental cost-effectiveness ratios (ICERs, in US$/year-of-life-saved [YLS], assuming a
ISSN:2731-4553
2731-4553
DOI:10.1101/2023.11.06.23298184