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Original article

An economic evaluation of conception strategies for heterosexual serodiscordant couples where the male partner is HIV-positive

Michelle Letchumanan, Peter C Coyte, Mona Loutfy

Corresponding author name: Mona Loutfy
Corresponding author e-mail: mona.loutfy@wchospital.ca

Citation: Antiviral Therapy 2015; 20:613-621
doi: 10.3851/IMP2956

Date accepted: 22 March 2015
Date published online: 07 April 2015

Abstract

Background: To conduct an economic evaluation of the three commonly used interventions that reduce sexual HIV transmission when an HIV-negative female aims to conceive with an HIV-positive male on combination antiretroviral therapy (condomless sex restricted to timed ovulation [CS], sperm washing with intrauterine insemination [SW] and condomless sex restricted to timed ovulation with pre-exposure prophylaxis [CS-PrEP]). As SW and CS-PrEP are only privately available for pregnancy planning for this population in Canada, this study was conducted to inform policy decisions concerning potential public health insurance coverage, as well as to inform fertility counselling in settings with adequate combination antiretroviral therapy access globally.

Methods: We developed a cohort Markov model with a lifetime horizon and used the perspective of Ontario’s Ministry of Health (MOH). Input parameters were drawn from literature, the MOH’s Schedule of Benefits and a time trade-off questionnaire designed for this study. Outcome measures included quality-adjusted life-years and incremental cost-effectiveness. Costs and benefits were discounted at annual rates of 3%. Costs were reported in Canadian 2013 dollars and an exchange rate of 1 USD to 1.066 CND was applied where necessary. Sensitivity analysis assessed the uncertainty of model parameters.

Results: The base case analysis found that CS-PrEP and SW were each more costly and less effective at conception than CS. The results were robust in the sensitivity analysis and suggest that CS is the dominant conception strategy in this population.

Conclusions: Neither CS-PrEP nor SW represent better value for money relative to CS as a conception option for HIV-discordant couples with positive male partners. Based on these findings, CS-PrEP and SW cannot be recommended for public-funding in developed countries.

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