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Cost-effectiveness of Zvandiri, a community-based support intervention to reduce virological failure in adolescents living with HIV in Zimbabwe: Results of a decision analytical model

Author

Listed:
  • Collin Mangenah
  • Webster Mavhu
  • Nicola Willis
  • Juliet Mufuka
  • Sarah Bernays
  • Walter Mangezi
  • Tsitsi Apollo
  • Ricardo Araya
  • Helen A Weiss
  • Alfredo Palacios
  • Fern Terris-Prestholt
  • Frances M Cowan
  • Hendramoorthy Maheswaran

Abstract

Improving antiretroviral therapy (ART) adherence among adolescents living with HIV (ALHIV) improves outcomes, but with resource implications. We conducted a cost-effectiveness analysis extrapolating the costs and benefits of a community-based peer-support intervention (Zvandiri) among ALHIV in Zimbabwe. We used a de-novo multistate Markov decision-analytic model that simulated Zvandiri lifetime costs and benefits on viral suppression, death rates, life-years (LY) and quality-adjusted-life-years (QALYs) gained from the healthcare system perspective. We estimate the incremental cost-effectiveness ratio (ICER) per LY and QALY gained and compare the ICER to proposed cost-effectiveness thresholds of $500 and $700 per LY or QALY gained. We explore parameter uncertainty using probabilistic sensitivity analyses. Cohort-microsimulation suggests that after 40 years under SoC, 21% of 280 ALHIV will have undetectable viral-load (VL), 12% will have low VL (

Suggested Citation

  • Collin Mangenah & Webster Mavhu & Nicola Willis & Juliet Mufuka & Sarah Bernays & Walter Mangezi & Tsitsi Apollo & Ricardo Araya & Helen A Weiss & Alfredo Palacios & Fern Terris-Prestholt & Frances M , 2025. "Cost-effectiveness of Zvandiri, a community-based support intervention to reduce virological failure in adolescents living with HIV in Zimbabwe: Results of a decision analytical model," PLOS Global Public Health, Public Library of Science, vol. 5(12), pages 1-18, December.
    • Handle: RePEc:plo:pgph00:0005545
    DOI: 10.1371/journal.pgph.0005545
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