Findings probably do not apply to rest of sub-Saharan Africa

EDITOR—Söderlund et al report the cost effectiveness of options available in South Africa to prevent the vertical transmission of HIV.1 I have concerns about the applicability of their findings (from an urban South African hospital setting) to the rest of sub-Saharan Africa.1 The paper's conclusion that the treatment is cost effective assumes that each child in whom seroconversion is prevented would otherwise have consumed substantial hospital resources.

From the figures in the paper, I calculate that at least £0.33-1.73 ($0.50-2.60) per capita is spent just on HIV positive children aged under 1 in an average sub-Saharan country. This clearly does not apply to a country like Malawi, whose health expenditure is around £2.70 ($4) per capita. This cost-benefit conclusion is not applicable to most of sub-Saharan Africa, where children with HIV infection are generally treated at home and at health centres Altogether 70-80% of public health costs in most health systems are staff costs and the salaries of health workers; thus even in South Africa the postulated hospital health cost savings in the analysis could not be recovered to fund the additional drug costs.

Using the authors' figures, I calculate that the antiretroviral drugs alone (£59 ($89) (PETRA regimen) to £267 ($400) (ACTGO76 regimen) per person treated) would cost an average …