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

Carolina Rosadas; Kátia Senna; Milene da Costa; Tatiane Assone; Jorge Casseb; Youko Nukui; Lucy Cook; Lívia Mariano; Bernardo Galvão Castro; Maria Fernanda Rios Grassi; Augusto Cesar Penalva de Oliveira; Adele Caterino-de-Araujo; Bassit Malik; Ney Boa-Sorte; Paula Peixoto; Marzia Puccioni-Sohler; Marisa Santos; Graham Philip Taylor

doi:10.1016/S2214-109X(23)00065-7

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

Carolina Rosadas^*, Kátia Senna, Milene da Costa, Tatiane Assone, Jorge Casseb, Youko Nukui, Lucy Cook, Lívia Mariano, Bernardo Galvão Castro, Maria Fernanda Rios Grassi, Augusto Cesar Penalva de Oliveira, Adele Caterino-de-Araujo, Bassit Malik, Ney Boa-Sorte, Paula Peixoto, Marzia Puccioni-Sohler, Marisa Santos, Graham Philip Taylor

^*Corresponding author for this work

Applied Health Sciences

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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$11 415 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.

FUNDING: None.

TRANSLATIONS: For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.

Original language	English
Pages (from-to)	e781-e790
Number of pages	10
Journal	Lancet Global Health
Volume	11
Issue number	5
Early online date	14 Apr 2023
DOIs	https://doi.org/10.1016/S2214-109X(23)00065-7
Publication status	Published - May 2023

Bibliographical note

Keywords

Infant
Female
Humans
Pregnancy
Human T-lymphotropic virus 1
Brazil/epidemiology
Access to Information
Infectious Disease Transmission, Vertical/prevention & control
Prenatal Diagnosis
Cost-Benefit Analysis
T-Lymphocytes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

Rosadas, C., Senna, K., da Costa, M., Assone, T., Casseb, J., Nukui, Y., Cook, L., Mariano, L., Galvão Castro, B., Rios Grassi, M. F., Penalva de Oliveira, A. C., Caterino-de-Araujo, A., Malik, B., Boa-Sorte, N., Peixoto, P., Puccioni-Sohler, M., Santos, M., & Taylor, G. P. (2023). Economic analysis of antenatal screening for human T-cell lymphotropic virus type 1 in Brazil: an open access cost-utility model. Lancet Global Health, 11(5), e781-e790. https://doi.org/10.1016/S2214-109X(23)00065-7

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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\$11 415 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.FUNDING: None.TRANSLATIONS: For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.",

keywords = "Infant, Female, Humans, Pregnancy, Human T-lymphotropic virus 1, Brazil/epidemiology, Access to Information, Infectious Disease Transmission, Vertical/prevention \& control, Prenatal Diagnosis, Cost-Benefit Analysis, T-Lymphocytes",

author = "Carolina Rosadas and K{\'a}tia Senna and \{da Costa\}, Milene and Tatiane Assone and Jorge Casseb and Youko Nukui and Lucy Cook and L{\'i}via Mariano and \{Galv{\~a}o Castro\}, Bernardo and \{Rios Grassi\}, \{Maria Fernanda\} and \{Penalva de Oliveira\}, \{Augusto Cesar\} and Adele Caterino-de-Araujo and Bassit Malik and Ney Boa-Sorte and Paula Peixoto and Marzia Puccioni-Sohler and Marisa Santos and Taylor, \{Graham Philip\}",

note = "Copyright {\textcopyright} 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.",

year = "2023",

month = may,

doi = "10.1016/S2214-109X(23)00065-7",

language = "English",

volume = "11",

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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 2023, 'Economic analysis of antenatal screening for human T-cell lymphotropic virus type 1 in Brazil: an open access cost-utility model', Lancet Global Health, vol. 11, no. 5, pp. e781-e790. https://doi.org/10.1016/S2214-109X(23)00065-7

TY - JOUR

T1 - Economic analysis of antenatal screening for human T-cell lymphotropic virus type 1 in Brazil

T2 - an open access cost-utility model

AU - Rosadas, Carolina

AU - Senna, Kátia

AU - da Costa, Milene

AU - Assone, Tatiane

AU - Casseb, Jorge

AU - Nukui, Youko

AU - Cook, Lucy

AU - Mariano, Lívia

AU - Galvão Castro, Bernardo

AU - Rios Grassi, Maria Fernanda

AU - Penalva de Oliveira, Augusto Cesar

AU - Caterino-de-Araujo, Adele

AU - Malik, Bassit

AU - Boa-Sorte, Ney

AU - Peixoto, Paula

AU - Puccioni-Sohler, Marzia

AU - Santos, Marisa

AU - Taylor, Graham Philip

PY - 2023/5

Y1 - 2023/5

N2 - 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$11 415 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.FUNDING: None.TRANSLATIONS: For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.

AB - 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$11 415 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.FUNDING: None.TRANSLATIONS: For the Portuguese and Spanish translations of the abstract see Supplementary Materials section.

KW - Infant

KW - Female

KW - Humans

KW - Pregnancy

KW - Human T-lymphotropic virus 1

KW - Brazil/epidemiology

KW - Access to Information

KW - Infectious Disease Transmission, Vertical/prevention & control

KW - Prenatal Diagnosis

KW - Cost-Benefit Analysis

KW - T-Lymphocytes

U2 - 10.1016/S2214-109X(23)00065-7

DO - 10.1016/S2214-109X(23)00065-7

M3 - Article

C2 - 37061315

SN - 2214-109X

VL - 11

SP - e781-e790

JO - Lancet Global Health

JF - Lancet Global Health

IS - 5

ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

Access to Document

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Cite this