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, Connor EM, Sperling RS, Gelber R, Kiselev P, Scott G, O’Sullivan MJ, VanDyke R, Bey M, Shearer W, Jacobson RL : Reduction of maternal-infant transmission of human immunodeﬁciency virus type + with zidovudine treatment : Pediatric AIDS Clinical Trials Group Protocol*10Study Group. N Engl J Med,--+: ++1-ῌ++2*,+33..

- Mandelbrot L, Le Chenadec J, Berrebi A, Bongain A, -.

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Beniﬂa J-L, Delfraissy J-F, Blanche S, Mayaux M-J : Perinatal HIV-+ transmission interacton between zidovudine prophylaxis and mode of deliverry in the french perinatal cohort. JAMA,,2*://ῌ0*,+332.

. HIV

:HIV-+

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Evaluation of the Most Adequate Prevention Strategy of HIV Mother-to-Child Transmission in Japan,

through Computer Simulation

Junichi I

^NABA⁺^),^.^῍

, Akari N

^AGAMATSU⁺^῍

, Shigeki M

^INOURA⁺^῍

, Hirofumi M

IYAZAWA^,^῍

, Akira Y

ASUOKA^-^῍

,

Shinichi O

^KA^-^῍

and Toru C

^HOSA^.^῍

+῍International Medical Center of Japan, Obstetrics & Gynecology

,῍International Medical Center of Japan, Pediatrics

-῍International Medical Center of Japan, AIDS Clinical Center

.῍International Medical Center of Japan, Bureau of International Cooperation

Objective: The purpose of this study is to investigate the most cost e#ective strategy for the Prevention of HIV Mother-to-Child Transmission (PMCT) in Japan.

Methods: A comprehensive computer simulation method with Microsoft Excel,***was used in this study. We selected the four well-known PMCT protocols ;+) ACTG*10,,) ACTG*10῎Elective Caesarian Section (C/S),-) Elective C/S only, and.) HIVENT*+,. The total PMCT cost was deﬁned as the sum of the indirect prevention costs like regular antenatal (or prenatal) check ups and direct prevention costs including maternal HIV test, labor expenses, medication fees, baby formula, PCR tests and C/S expenses. “No prevention strategy” was also simulated as a control. Every cost was calculated based on the national health insurance credits. Each vertical transmission rate was quoted from past large-scale studies. The e#ectiveness of every prevention strategy was evaluated with both the expected number of non-infected infants through each strategy and its total PMCT cost. The reported current HIV prevalence rate among pregnant women in Japan is about*.*,ῌ; however, we also investigated on the assumption that will be from*.**/ῌto+.*ῌrespectively to simulate future HIV prevalence situations in Japan.

Results: When the HIV prevalence rate surpassed *.*,ῌ, “ACTG*10῎elective C/S”

showed the most cost e#ective result, on the condition that the life-long medication cost per one HIV-infected child is1/million yen (equal to nearly US$0-*,***). When the prevalence rate was*.*,ῌand below, however, there were no signiﬁcant di#erence among strategies.

Conclusion: “ACTG*10῎elective C/S” will be the most cost-e#ective and morally accept- able strategy to cope with the prospective increase of HIV-positive pregnancy in Japan in the future as well as in the current situation.

Key words: HIV/AIDS, PMCT (PMTCT), cost-benefit ratio, ACTG*10, elective C/S

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