Cost-Effectiveness of an Integrated Antenatal Care Testing Panel to Accelerate the Triple Elimination of Mother-to-Child Transmission of HIV, Syphilis, and Hepatitis B in Nigeria: Modeling Study
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Background
In 2025, the World Health Organization pre-qualified an integrated antenatal care (ANC) testing panel that tests for HIV (including p24 antigen and antibody), syphilis, and hepatitis B (HBV) with one finger prick. The panel would accelerate the triple elimination of vertically transmitted infections by shortening the HIV detection window and increasing testing rates. Nigeria is considering adoption but needs performance and cost projections.
Methods
We constructed deterministic (with Microsoft Excel) and probabilistic (with Python) models, including parallel testing and treatment post-exposure prophylaxis algorithms for positive p24. We calibrated the models to Nigeria’s 6.4 million women entering ANC annually using epidemiologic literature, product prices, and occasionally expert opinion. We compared costs (in 2025 US dollars) and outcomes between current and projected future (2027) practices.
Results
The panel would avert 562 of the current 3,299 vertical infections per 100,000 women in ANC. Per woman in ANC, the panel would avert 0.0656 disability adjusted life years (DALYs) at a net cost of US$7.55. With low current testing rates. HBV testing averts the most DALYs (33%), followed by acute HIV (29%), chronic HIV (25%), and syphilis (14%). The incremental cost-effectiveness ratio (ICER) is $115 (95% confidence interval: $91-$143) per DALY averted--more favorable than Nigeria’s conservative historical $137 average. The benefit-cost ratio is also favorable (1.19; 95% confidence interval: 0.93-1.51).
Conclusions
The integrated ANC testing panel would be a valuable and cost-effective addition to ANC care. Piloting in Nigeria and similar sub-Saharan African countries would refine parameters for potential scale up.
