Spreadsheet: 04ccdaaf-8b06-41c3-a52b-189040dff6f6
Sheet: 3. Costing Tool

 | Costing Tool | Target Scenario | Intermediate Scenario 2 | Intermediate Scenario 1 | Current Scenario  with ANC data | Current Scenario without ANC data
 | Estimated number of births | 100000 | 100000 | 100000 | 100000 | 100000
 | HIV prevalence among pregnant women (%) | 0.5 | 0.5 | 0.5 | 0.5 | 0.5
 | ANC attendance (%) | 95 | 90 | 90 | 90 | -
 | Percentage of pregnant women who had the HIV test (%) | 95 | 85 | 75 | 65 | 40
 | Percentage of pregnant women tested HIV positive during ANC who received ARVs (%) | 95 | 85 | 75 | 65 | 40
 | Pregnant women with HIV diagnosis previous to current pregnancy who receive ART (%) | 16 | 16 | 16 | 16 | 16
 | Breastfeeding in general population (average in MONTHS) | 14 | 14 | 14 | 14 | 14
 | Expected mother-to-child HIV transmission rate without intervention (%) (women with CD4 < 350)  (32 % + breastfeeding)
 | Expected mother-to-child HIV transmission rate without intervention (%) (women with CD4 > 350)  (15 % + breastfeeding)
 | Expected mother-to-child HIV transmission rate with intervention in pregnant women diagnosed during pregnancy:  2%  (It is assumed that there is no breastfeeding) | 2 | 2 | 2 | 2 | 2
 | Expected mother-to-child HIV transmission rate with intervention in pregnant women on ART previous to pregnancy:  0.5%  (It is assumed that there is no breastfeeding) | 0.5 | 0.5 | 0.5 | 0.5 | 0.5
 | Number of HIV positive pregnant women
 | Number of HIV positive pregnant women who received HIV testing and ARVs
 | Expected number of children infected through MTCT whose mother accessed ANC, received HIV testing and ART or ARVs prophylaxis
 | Expected number of children infected through MTCT whose mother accessed ANC and received HIV testing, but did not receive ART or ARVs prophylaxis
 |  |  |  |  |  | 0
 | Expected number of children infected through MTCT whose mother either accessed ANC but did not receive HIV testing or did not access both ANC and HIV testing
 | Total number of children infected with HIV through MTCT
 | Total MTCT rate
 | Total number of HIV infections averted
 | PMTCT
 | HIV screening at ANC
 | Unit cost of HIV test (screening) | 1 | 1 | 1 | 1 | 1
 | Unit cost of HIV test (confirmation) | 2 | 2 | 2 | 2 | 2
 | Total cost of HIV testing (screening) for all pregnant women
 | Total cost of HIV testing (confirmation) for HIV positive pregnant women
 | Total cost of HIV testing for partners of HIV positive pregnant women
 | Unit cost of counselling for HIV positive pregnant women | 16 | 16 | 16 | 16 | 16
 | Total cost of counselling for HIV positive pregnant women
 | Unit cost of CD4 test | 10 | 10 | 10 | 10 | 10
 | Total cost of CD4 test for HIV positive pregnant women (twice during antenatal)
 | Unit cost of viral load | 40 | 40 | 40 | 40 | 40
 | Total cost of viral load for HIV positive pregnant women (twice during antenatal)
 | ARV prophylaxis for pregnant women and exposed infants
 | Unit cost of ARVs (in USD) |  |  | Drug wastage (%)
 | ABC 300mg | 0.26 |  | Tablets | 5
 | AZT 10mg/mL | 0.01 |  | Syrups | 20
 | AZT 300mg | 0.11
 | AZT 300mg/3TC 150mg | 0.14
 | AZT 300mg/3TC 150mg/NVP 200mg | 0.18
 | EFV 600mg | 0.14
 | LPV/r 200mg/50mg | 0.29
 | NVP 10mg/mL | 0.01
 | TDF [NAME]EFV 600mg | 0.58
 | TDF 300mg/FTC 200mg/EFV 600mg | 0.66
 | 1)  Pregnant women who are eligible for ART for their own health
 | Percentage of HIV positive pregnant women who are eligible for ART or already on ART (%) | 40 | 40 | 40 | 40 | 40
 | Percentage of ART eligible women who are on AZT+3TC+NVP (%) | 100 | 100 | 100 | 100 | 100
 | Percentage of ART eligible women who are on AZT+3TC+LPV/r (%)
 | Selected regimen for child (AZT) | 2 | 2 | 2 | 2 | 2
 | Mother on ART: Cost of drug per mother on AZT+3TC+NVP
 | Mother on ART: Cost of drug per mother on AZT+3TC+LPV/r
 | Mother on ART: Cost of drug per child
 | Mother on ART: Total cost of drug for women who accessed ANC services
 | Mother on ART: Total cost of drug for children of mothers who accessed ANC services
 | Total costs
 | 2) Pregnant women who are NOT eligible for ART for their own health
 | Percentage of HIV positive pregnant women who are not eligible for ART (%)
 | Selected regimen for mother AZT+3TC+LPV/r with replacement feeding | 6 | 6 | 6 | 6 | 6
 | Selected regimen for child (AZT) | 2 | 2 | 2 | 2 | 2
 | Cost of drug per mother
 | Cost of drug per child
 | Cost of drugs for mothers who accessed ANC services
 | Cost of drugs for children of mothers who accessed ANC services
 | Total costs
 | Replacement feeding
 | Weight of formula per tin | 900
 | Unit cost per tin (in USD) | 15
 | Volume of formula per 50ml of water (g) | 7.9
 | Length of replacement feeding (0, 6, 12, 18 months) | 6 | 6 | 6 | 6 | 6
 | Cost of formula per child
 | Total cost of formula for children who accessed services
 | Other costs for PMTCT
 | Percentage of HIV positive pregnant women who deliver by cesarean section | 100 | 100 | 100 | 100 | 100
 | Percentage of HIV positive pregnant women who have vaginal delivery
 | Cost of cesarean section (including AZT iv) (in USD) | 240 | 240 | 240 | 240 | 240
 | Cost of vaginal delivery (including AZT iv) (in USD) | 120 | 120 | 120 | 120 | 120
 | Cost difference between caesarean section and vaginal delivery
 | Additional cost of providing caesarean section for HIV positive pregnant women
 | Cost of co-trimoxazole prophylaxis up to 18 months (per exposed infant) | 14.2 | 14.2 | 14.2 | 14.2 | 14.2
 | Total cost of co-trimoxazole prophylaxis for exposed children
 | Unit cost of HIV virological test (PCR) for exposed children | 40 | 40 | 40 | 40 | 40
 | Unit cost of HIV serological test for exposed children | 1 | 1 | 1 | 1 | 1
 | Total cost of laboratory diagnosis for exposed children
 | Unit cost of counselling for caregivers of HIV positive children | 16 | 16 | 16 | 16 | 16
 | Total cost of counselling for caregivers of HIV positive children
 | Cost of health service (PMTCT follow up) per visit | 7 | 7 | 7 | 7 | 7
 | Total number of visits (14 weeks of pregnancy till 18 months after birth) | 20 | 20 | 20 | 20 | 20
 | Total cost of health service for PMTCT
 | Total costs of PMTCT
 | Prevention of congenital syphilis
 | Syphilis prevalence among pregnant women (%) | 1 | 1 | 1 | 1 | 1
 | Percentage of pregnant women who had syphilis test (%) | 95 | 85 | 75 | 65 | 50
 | Percentage of pregnant women with maternal syphilis who received treatment by 24 weeks of pregnancy (%) | 95 | 85 | 75 | 65 | 95
 | Unit cost of syphilis test (screening) | 0.7 | 0.7 | 0.7 | 0.7 | 0.7
 | Total cost of syphilis test for pregnant women (twice during antenatal)
 | Total cost of syphilis test for partners of seropositive pregnant women
 | Unit cost of benzylpenicillin/2.4million unit | 0.5 | 0.5 | 0.5 | 0.5 | 0.5
 | Total cost of treatment for seropositive pregnant women (3 doses)
 | Total cost of treatment for partners of seropositive pregnant women (1 dose)
 | Unit cost of benzylpenicillin/150,000 unit (exposed infants) | 0.3 | 0.3 | 0.3 | 0.3 | 0.3
 | Total cost of treatment for infants born to seropositive women
 | Unit cost of syphilis test (diagnosis for infants) | 0.7 | 0.7 | 0.7 | 0.7 | 0.7
 | Total cost of diagnosis for infants born to seropositive women (serological test x 3 times)
 | Total costs of prevention of congenital syphilis
 | Treatment for paediatric HIV infection
 | Unit cost of ARVs (in USD) |  |  | Drug wastage (%)
 | AZT 60mg/3TC 30mg/NVP 50mg | 0.14 |  | Tablets | 5
 | AZT 300mg/3TC 150mg/NVP 200mg | 0.18 |  | Syrups | 20
 | AZT 60mg/3TC 30mg | 0.05
 | AZT 300mg/3TC 150mg | 0.14
 | LPV/r 80mg/ 20mg | 0.27
 | LPV/r 100 mg/25 mg | 0.15
 | EFV 200mg | 0.06
 | HIV, CD4 and Viral load testing
 | Unit cost of HIV virological test (PCR) for exposed children
 | Total cost of HIV test for exposed children whose mother did not access PMTCT services
 | Unit cost of CD4 test
 | Unit cost of viral load
 | Total cost of initial CD4 test and viral load for HIV infected children
 | Unit cost of counselling for caregivers of HIV positive children
 | Total cost of counselling for caregivers of HIV positive children
 | Children whose mothers accessed PMTCT services
 | 1)  Treatment for children with prior exposure to NVP (AZT/3TC/LPV/r)
 | Number of children with NVP exposure - mother on ART
 | Cost of treatment per child
 | Total cost of treatment
 | 2) Treatment for children without prior exposure to NVP
 | Selected regimen  1. AZT+3TC+NVP 2. AZT+3TC+LPV/r | 1 | 1 | 1 | 1 | 1
 | Number of children without prior exposure to NVP
 | Cost of treatment per child
 | Total cost of treatment
 | Children whose mothers did NOT access PMTCT services
 | Selected regimen 1. AZT+3TC+NVP 2. AZT+3TC+EFV 3. AZT+3TC+LPV/r | 1 | 1 | 1 | 1 | 1
 | Number of children whose mothers did not access PMTCT services
 | Cost of treatment per child
 | Total cost of treatment
 | Other costs related to paediatric HIV treatment
 | Cost of co-trimoxazole prophylaxis for 5 years per child | 50 | 50 | 50 | 50 | 50
 | Total cost of co-trimoxazole prophylaxis for infected children
 | Cost of health service (out-patient visit) per visit | 10 | 10 | 10 | 10 | 10
 | Number of visits per year per child | 5 | 5 | 5 | 5 | 5
 | Total cost of health service per child per year
 | Total cost of health service (out-patient visit) for infected children
 | Cost of laboratory monitoring per year per child | 190 | 190 | 190 | 190 | 190
 | Total cost of laboratory monitoring for infected children
 | Children on 2nd line regimen
 | Rate of treatment failure (switch to 2nd line regimen) per year (%) | 2 | 2 | 2 | 2 | 2
 | Cost difference between 1st and 2nd line regimen (per person per year) | 400 | 400 | 400 | 400 | 400
 | Years needed for all children to be on 2nd line
 | Cost if all children switched to 2nd line
 | Cost in the case that not all children switched to 2nd line before the end of pediatric treatment period
 | Additional cost due to treatment failure
 | Total costs of paediatric HIV treatment
 | Grand total (cost of PMTCT + cost of prevention of congenital syphilis + cost of paediatric HIV treatment)
 | Summary
 | Total number of HIV infection averted (children protected from MTCT)
 | Cost per infection averted (cost of PMTCT/# of infection averted)
 | Average cost of paediatric treatment per child (cost of paediatric treatment/# of infected children)
 | Total savings (average cost of paediatric treatment x # of infection averted - total cost of PMTCT)
 | Total number of fetal loss and stillbirths due to syphilis averted
 | Total number of perinatal deaths due to syphilis averted
 | Total number of serious neonatal syphilis infection averted
 | Total number of prematurity or low birth weight due to syphilis averted
 | Cost per congenital syphilis case averted
 | Total number of HIV positive pregnant women identified and referred for ART
 | (costs are in USD)