Economic analysis of antenatal screening for human T-cell lymphotropic virus type 1 in Brazil: an open access cost-utility model
Lancet Glob Health
; 11(5): e781-e790, 2023. tab, graf
Article
in English
| Coleciona SUS, Sec. Est. Saúde SP, SESSP-ACVSES, SESSP-IALPROD, Sec. Est. Saúde SP
| ID: biblio-1428440
Responsible library:
BR91.2
Localization: BR91.2; P / BR76.1; P
ABSTRACT
Background Human T-cell lymphotropic virus type 1 (HTLV-1) is a retrovirus that causes severe diseases, such as aggressive cancer or progressive neurological disease. HTLV-1 affects mainly people in areas with low human development index and can be transmitted from mother to child, primarily through breastfeeding. Refraining from breastfeeding is an effective intervention to reduce the risk of infection in infants. However, HTLV-1 antenatal screening is not offered globally. According to WHO, the scarcity of cost-effectiveness studies is considered one of the major barriers to the implementation of policies to prevent HTLV-1 infection. Therefore, this study aimed to assess the cost-effectiveness of antenatal screening and postnatal interventions to prevent HTLV-1 mother-to-child transmission in Brazil and to develop an open-access, editable, mathematical model that can be used by other countries and regions to assess different scenarios. Methods In this cost-utility analysis, we constructed a decision tree and a Markov model to assess the cost-effectiveness of HTLV-1 antenatal screening and postnatal interventions (ie, avoidance of breastfeeding, by suppression of lactation with cabergoline, and provision of formula feed) to reduce transmission. For our model, we used data from Brazil and we took the perspective of the public health-care system to estimate costs. Findings The implementation of both screening and interventions would result in the prevention of 1039 infections in infants every year in Brazil with an incremental cost-effectiveness ratio (ICER) of US$11415 per quality-adjusted lifeyear (QALY). 88% of all probabilistic sensitivity analysis simulations had ICER values lower than the Brazilian costeffectiveness threshold ($18 107·74 per QALY). HTLV-1 prevalence in pregnant women, the risk of HTLV-1 transmission when breastfeeding lasts for 6 months or more, and the cost of screening tests were the variables with the largest effect on ICER. Interpretation HTLV-1 antenatal screening is cost-effective in Brazil. An open-access model was developed, and this tool could be used to assess the cost-effectiveness of such policy globally, favouring the implementation of interventions to prevent HTLV-1 mother-to-child transmission worldwide. (AU)
Full text:
Available
Collection:
National databases
/
Brazil
Health context:
Sustainable Health Agenda for the Americas
Health problem:
Goal 4: Health financing
Database:
Sec. Est. Saúde SP
/
SESSP-ACVSES
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SESSP-IALPROD
/
Coleciona SUS
Main subject:
Prenatal Diagnosis
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Brazil
/
T-Lymphocytes
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Human T-lymphotropic virus 1
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Cost-Benefit Analysis
Type of study:
Diagnostic study
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Health economic evaluation
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Prognostic study
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Risk factors
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Screening study
Country/Region as subject:
South America
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Brazil
Language:
English
Journal:
Lancet Glob Health
Year:
2023
Document type:
Article
Institution/Affiliation country:
Escola Bahiana de Medicina e Saúde Pública/BR
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Fundação Oswaldo Cruz/BR
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Imperial College Healthcare NHS Trust/GB
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Imperial College London/GB
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Instituto Adolfo Lutz/BR
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Instituto Nacional de Cardiologia/BR
/
Instituto de Infectologia Emílio Ribas/BR
/
Universidade Estácio de Sá/BR
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Universidade Federal do Estado do Rio de Janeiro/BR
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Universidade de São Paulo/BR