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Abstract：
BACKGROUND: Countries are currently progressing towards the elimination of new paediatric HIV infections by 2015. WHO published new consolidated guidelines in June 2013, which now recommend either \'Antiretroviral drugs (ARVs) for women living with HIV during pregnancy and breastfeeding (Option B)\' or \'Lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women living with HIV (Option B+)\', while de facto phasing out Option A. This study examined health outcomes and cost impact of the shift to WHO 2013 recommendations in Zambia.
METHODS: A decision analytic model was developed based on the national health system perspective. Estimated risk and number of cases of HIV transmission to infants and to serodiscordant partners, and proportions of HIV-infected pregnant women with CD4 count of ≤350 cells/mm3 to initiate ART were compared between 2010 Option A and the 2013 recommendations. Total costs of prevention of mother-to-child transmission of HIV (PMTCT) services per annual cohort of pregnant women, incremental cost-effectiveness ratio (ICER) per infection averted and quality-adjusted life-year (QALY) gained were examined.
RESULTS: Our analysis suggested that the shift from 2010 Option A to the 2013 guidelines would result in a 33% reduction of the risk of HIV transmission among exposed infants. The risk of transmission to serodiscordant partners for a period of 24 months would be reduced by 72% with \'ARVs during pregnancy and breastfeeding\' and further reduced by 15% with \'Lifelong ART\'. The probability of HIV-infected pregnant women to initiate ART would increase by 80%. It was also suggested that while the shift would generate higher PMTCT costs, it would be cost-saving in the long term as it spares future treatment costs by preventing infections in infants and partners.
CONCLUSIONS: The shift to the WHO 2013 guidelines in Zambia would positively impact health of family and save future costs related to care and treatment.
METHODS: A decision analytic model was developed based on the national health system perspective. Estimated risk and number of cases of HIV transmission to infants and to serodiscordant partners, and proportions of HIV-infected pregnant women with CD4 count of ≤350 cells/mm3 to initiate ART were compared between 2010 Option A and the 2013 recommendations. Total costs of prevention of mother-to-child transmission of HIV (PMTCT) services per annual cohort of pregnant women, incremental cost-effectiveness ratio (ICER) per infection averted and quality-adjusted life-year (QALY) gained were examined.
RESULTS: Our analysis suggested that the shift from 2010 Option A to the 2013 guidelines would result in a 33% reduction of the risk of HIV transmission among exposed infants. The risk of transmission to serodiscordant partners for a period of 24 months would be reduced by 72% with \'ARVs during pregnancy and breastfeeding\' and further reduced by 15% with \'Lifelong ART\'. The probability of HIV-infected pregnant women to initiate ART would increase by 80%. It was also suggested that while the shift would generate higher PMTCT costs, it would be cost-saving in the long term as it spares future treatment costs by preventing infections in infants and partners.
CONCLUSIONS: The shift to the WHO 2013 guidelines in Zambia would positively impact health of family and save future costs related to care and treatment.
摘要：
背景：各国目前正在朝着到2015年消除新的儿科HIV感染的方向发展。世卫组织于2013年6月发布了新的综合指南，该指南现在建议“针对怀孕和母乳喂养期间感染艾滋病毒的妇女的抗逆转录病毒药物（ARV）（选项B）”或“针对所有怀孕和母乳喂养的妇女的终身抗逆转录病毒治疗（ART）艾滋病毒（选项B）”。本研究审查了赞比亚转向世卫组织2013年建议的健康结果和成本影响。
方法：基于国家卫生系统视角建立决策分析模型。艾滋病毒传播给婴儿和血清不一致伴侣的估计风险和病例数，在2010年方案A和2013年建议中,比较了CD4计数≤350个细胞/mm3的HIV感染孕妇开始ART的比例.每年孕妇队列中预防母婴传播艾滋病毒（PMTCT）服务的总费用，检查了每次避免感染的增量成本-效果比(ICER)和获得的质量调整生命年(QALY).
结果：我们的分析表明，从2010年方案A到2013年指南的转变将导致暴露婴儿中艾滋病毒传播风险降低33%。使用“怀孕和母乳喂养期间的抗逆转录病毒药物”，在24个月内传播给血清不一致伴侣的风险将降低72％，使用“终身ART”将进一步降低15％。感染艾滋病毒的孕妇开始ART的可能性将增加80％。还有人建议，虽然这种转变会产生更高的PMTCT成本，从长远来看，这将节省成本，因为它可以通过预防婴儿和伴侣的感染来节省未来的治疗成本。
结论：赞比亚向世卫组织2013年指南的转变将对家庭健康产生积极影响，并节省未来与护理和治疗相关的费用。
方法：基于国家卫生系统视角建立决策分析模型。艾滋病毒传播给婴儿和血清不一致伴侣的估计风险和病例数，在2010年方案A和2013年建议中,比较了CD4计数≤350个细胞/mm3的HIV感染孕妇开始ART的比例.每年孕妇队列中预防母婴传播艾滋病毒（PMTCT）服务的总费用，检查了每次避免感染的增量成本-效果比(ICER)和获得的质量调整生命年(QALY).
结果：我们的分析表明，从2010年方案A到2013年指南的转变将导致暴露婴儿中艾滋病毒传播风险降低33%。使用“怀孕和母乳喂养期间的抗逆转录病毒药物”，在24个月内传播给血清不一致伴侣的风险将降低72％，使用“终身ART”将进一步降低15％。感染艾滋病毒的孕妇开始ART的可能性将增加80％。还有人建议，虽然这种转变会产生更高的PMTCT成本，从长远来看，这将节省成本，因为它可以通过预防婴儿和伴侣的感染来节省未来的治疗成本。
结论：赞比亚向世卫组织2013年指南的转变将对家庭健康产生积极影响，并节省未来与护理和治疗相关的费用。
