Cost-Effectiveness of Integrating PMTCT and MNCH Services: An Application of the LiST Model for Malawi, Mozambique, and Uganda

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Executive Summary

Integrating health care services is thought to result in both cost savings and better outcomes through improving efficiency, quality, uptake and effectiveness of services. Integration is one of the seven core principles guiding the United States Global Initiative, and is recommended by the World Health Organization in its 2013 Consolidated Guidelines for Antiretroviral Therapy.

Although there is evidence on some aspects of the impacts of integration, such as increases in coverage rates for various interventions, there is little evidence regarding actual outcome variables. In this paper we utilize the empirical evidence available on the impact of integration on coverage rates and costs to model the impact of integrating services to prevent mother-to-child transmission with antenatal clinic sites on infant HIV infections averted, and also the impact of integrating family planning services into HIV care facilities. We calculate incremental cost-effectiveness ratios for a number of different scenarios using the LiST model for Malawi, Mozambique and Uganda.

We find that all of the integration strategies are cost-effective, with all of the scenarios except one being highly cost-effective. In fact, a majority of the scenarios examined actually report cost savings, particularly when the interactive and dynamic effects that are modeled across the different modules are included; for example, increasing family planning results in lower costs for providing health care to children, including immunization, because there are fewer children born.

We conclude that, although few empirical results exist regarding the incremental cost-effectiveness ratios associated with integrating HIV and MNCH services, the modeled evidence confirms that there are, indeed, significant benefits to integration.

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