Cost Effectiveness of Paediatric Antiretroviral Therapy in Low Resource Settings: The Zambian Case

Abstract

This paper presents a cost-effectiveness analysis (CEA) of paediatric ARV administration in Zambia using cotrimoxazole as a comparator. The CEA was facilitated by the paediatric formulations provided by the Indian company Cipla Limited for the CHAPAS (Children with HIV in Africa – Pharmacokinetics and Adherence of Simple Antiretroviral Regimens) randomized controlled trials. The study design for ARVs was an open, randomised and controlled phase I and II trial, in which 220 children were recruited using a set of inclusive and exclusive criteria and randomised on the basis of 1:1 ratio. Two models were used for analysis: Cost-effectiveness analysis and the Markov stochastic model. The integrated results on a number of outcomes such as the CD4 distribution over time, cost estimates, estimates of transition probabilities, estimates of life expectancy, survival curves, incremental cost effectiveness ratios and net health benefits attest the dominance of the ARVs over cotrimoxazole and its high desirability of use as a vital complement to the comparator drug which has its own merit as a low-cost intervention..

Keywords: Paediatric ARV, Incremental Cost Effectiveness Ratio, Markov model, net health benefits, survival analysis