Economic analysis of antenatal screening for human T-cell lymphotropic virus type 1 in Brazil: an open access cost-utility model

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dc.contributor.authorRosadas, Carolina
dc.contributor.authorSenna, Kátia
dc.contributor.authorCosta, Milene da
dc.contributor.authorAssone, Tatiane
dc.contributor.authorCasse, Jorge
dc.contributor.authorNukui, Youko
dc.contributor.authorCook, Lucy
dc.contributor.authorMariano, Lívia
dc.contributor.authorCastro, Bernardo Galvão
dc.contributor.authorGrassi, Maria Fernanda Rios
dc.contributor.authorOliveira, Augusto Cesar Penalva de
dc.contributor.authorCaterino-de-Araujo, Adele
dc.contributor.authorMalik, Bassit
dc.contributor.authorBoa-Sorte, Ney
dc.contributor.authorPeixoto, Paula
dc.contributor.authorPuccioni-Sohler, Marzia
dc.contributor.authorSantos, Marisa
dc.contributor.authorPhilip Taylor, Graham
dc.date.accessioned2024-10-25T16:53:22Z
dc.date.available2024-10-25T16:53:22Z
dc.date.issued2023
dc.description.abstractBackground 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.
dc.identifier.citationRosadas 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
dc.identifier.otherDOI: 10.1016/S2214-109X(23)00065-7
dc.identifier.urihttps://dspace.inc.saude.gov.br/handle/123456789/535
dc.language.isoen
dc.publisherThe Lancet Global health
dc.subjectAccess to Informationen
dc.subjectBrazil / epidemiologyen
dc.subjectCost-Benefit Analysisen
dc.subjectFemaleen
dc.subjectHuman T-lymphotropic virus 1*en
dc.subjectHumansen
dc.subjectInfanten
dc.subjectInfectious Disease Transmission, Vertical / prevention & controlen
dc.subjectPregnancyen
dc.subjectPrenatal Diagnosisen
dc.subjectT-Lymphocytesen
dc.titleEconomic analysis of antenatal screening for human T-cell lymphotropic virus type 1 in Brazil: an open access cost-utility model
dc.typeArticle
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