Economic analysis of antenatal screening for human T-cell lymphotropic virus type 1 in Brazil: an open access cost-utility model
Economic analysis of antenatal screening for human T-cell lymphotropic virus type 1 in Brazil: an open access cost-utility model
Data
2023
Autores
Rosadas, Carolina
Senna, Kátia
Costa, Milene da
Assone, Tatiane
Casse, Jorge
Nukui, Youko
Cook, Lucy
Mariano, Lívia
Castro, Bernardo Galvão
Grassi, Maria Fernanda Rios
Journal Title
Journal ISSN
Volume Title
Publisher
The Lancet Global health
Resumo
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 life-
year (QALY). 88% of all probabilistic sensitivity analysis simulations had ICER values lower than the Brazilian cost-
effectiveness 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.
Description
Palavras-chave
Access to Information, Brazil / epidemiology, Cost-Benefit Analysis, Female, Human T-lymphotropic virus 1*, Humans, Infant, Infectious Disease Transmission, Vertical / prevention & control, Pregnancy, Prenatal Diagnosis, T-Lymphocytes
Citação
Rosadas C, Senna K, da Costa M, Assone T, Casseb J, Nukui Y, Cook L, Mariano L, Galvão Castro B, Rios Grassi MF, Penalva de Oliveira AC, Caterino-de-Araujo A, Malik B, Boa-Sorte N, Peixoto P, Puccioni-Sohler M, Santos M, Taylor GP. Economic analysis of antenatal screening for human T-cell lymphotropic virus type 1 in Brazil: an open access cost-utility model. Lancet Glob Health. 2023 May;11(5):e781-e790. doi: 10.1016/S2214-109X(23)00065-7