Economic analysis of HTLV-1 antenatal screening in Brazil: An open access cost-utility model

Background: Human T-cell lymphotropic virus type-1 (HTLV-1) is a retrovirus that causes severe diseases, such as an aggressive cancer and progressive neurological disease. HTLV-1 affects mainly areas with low human development index and may be transmitted from mother-to-child, primarily through breastfeeding. Refraining from breastfeeding is an effective intervention to reduce the risk of infant`s infection. However, HTLV-1 antenatal screening is not offered globally. According to the World Health Organization, the lack of cost-effectiveness studies is considered one of the major barriers for the implementation of policies to prevent HTLV-1 infection. Therefore, this study aimed to assess the cost- effectiveness of antenatal screening and intervention 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/regions to assess different scenarios. Methods: A decision tree combined with a Markov model was constructed to assess the cost-effectiveness of HTLV-1 antenatal screening and intervention to reduce transmission (avoidance of breastfeeding with cabergoline and provision of formula). The perspective of the Public Healthcare system was used. Data from Brazil were modelled. Findings: This intervention would result in the prevention of 1,039 infections in infants every year in Brazil with an incremental cost-effectiveness ratio (ICER) of U$11,415/QALY. 88$ 18,108). HTLV-1 prevalence among pregnant women, the risk of HTLV-1 transmission when breastfeeding for more than six months and cost of screening tests were the variables influencing most the ICER. Interpretation: HTLV-1 antenatal screening is cost-effective in Brazil. An open-access model was developed, and this tool can be potentially used to assess the cost-effectiveness of such policy globally, influencing the implementation of interventions to prevent HTLV-1 mother-to-child transmission worldwide