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We sought to estimate the potential clinical impact and cost\u2010effectiveness of hypothetical bNAb prophylaxis programmes for children known to be HIV exposed at birth in three sub\u2010Saharan African settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a cost\u2010effectiveness analysis using the CEPAC\u2010Pediatric model, simulating cohorts of infants from birth through death in C\u00f4te d'Ivoire, South Africa and Zimbabwe. These settings were selected to reflect a broad range of HIV care cascade characteristics, antenatal HIV prevalence and budgetary constraints. We modelled strategies targeting bNAbs to only WHO\u2010designated \u201chigh\u2010risk\u201d HIV\u2010exposed infants (<jats:italic>HR\u2010HIVE<\/jats:italic>) or to all HIV\u2010exposed infants (<jats:italic>HIVE<\/jats:italic>). We compared four prophylaxis approaches within each target population: standard of care oral antiretroviral prophylaxis (<jats:italic>SOC<\/jats:italic>), and<jats:italic>SOC<\/jats:italic>plus bNAbs at birth (<jats:italic>1\u2010dose<\/jats:italic>), at birth and 3 months (<jats:italic>2\u2010doses<\/jats:italic>), or every 3 months throughout breastfeeding (<jats:italic>Extended<\/jats:italic>). Base\u2010case model inputs included bNAb efficacy (60%\/dose), effect duration (3 months\/dose) and costs ($60\/dose), based on published literature. Outcomes included paediatric HIV incidence and incremental cost\u2010effectiveness ratios (ICERs) calculated from discounted life expectancy and lifetime HIV\u2010related costs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The model projects that bNAbs would reduce absolute infant HIV incidence by 0.3\u20132.2% (9.6\u201334.9% relative reduction), varying by country, prophylaxis approach and target population. In all three settings,<jats:italic>HR\u2010HIVE\u20131\u2010dose<\/jats:italic>would be cost\u2010saving compared to<jats:italic>SOC<\/jats:italic>. Using a 50% GDP per capita ICER threshold,<jats:italic>HIVE\u2010Extended<\/jats:italic>would be cost\u2010effective in all three settings with ICERs of $497\/YLS in C\u00f4te d'Ivoire, $464\/YLS in South Africa and $455\/YLS in Zimbabwe. In all three settings, bNAb strategies would remain cost\u2010effective at costs up to $200\/dose if efficacy is \u226530%. If the bNAb effect duration were reduced to 1 month, the cost\u2010effective strategy would become<jats:italic>HR\u2010HIVE\u20131\u2010dose<\/jats:italic>in C\u00f4te d'Ivoire and Zimbabwe and<jats:italic>HR\u2010HIVE\u20132\u2010doses<\/jats:italic>in South Africa. Findings regarding the cost\u2010effectiveness of bNAb implementation strategies remained robust in sensitivity analyses regarding breastfeeding duration, maternal engagement in postpartum care, early infant diagnosis uptake and antiretroviral treatment costs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>At current efficacy and cost estimates, bNAb prophylaxis for HIV\u2010exposed children in sub\u2010Saharan African settings would be a cost\u2010effective intervention to reduce vertical HIV transmission.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26052","type":"journal-article","created":{"date-parts":[[2023,1,6]],"date-time":"2023-01-06T03:55:04Z","timestamp":1672977304000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Cost\u2010effectiveness of broadly neutralizing antibody prophylaxis for HIV\u2010exposed infants in sub\u2010Saharan African settings"],"prefix":"10.1002","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6604-6111","authenticated-orcid":false,"given":"Caitlin M.","family":"Dugdale","sequence":"first","affiliation":[{"name":"Medical Practice Evaluation Center Department of Medicine Massachusetts General Hospital Boston Massachusetts USA"},{"name":"Division of Infectious Diseases Department of Medicine Massachusetts General Hospital Boston Massachusetts USA"},{"name":"Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ogochukwu","family":"Ufio","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center Department of Medicine Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8692-7656","authenticated-orcid":false,"given":"Christopher","family":"Alba","sequence":"additional","affiliation":[{"name":"Medical Practice Evaluation Center Department of Medicine Massachusetts General Hospital Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sallie R.","family":"Permar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Weill Cornell Medicine New York New York USA"},{"name":"Department of Pediatrics New York\u2010Presbyterian\/Weill Cornell Medical Center New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3566-1688","authenticated-orcid":false,"given":"Lynda","family":"Stranix\u2010Chibanda","sequence":"additional","affiliation":[{"name":"Child and Adolescent Health Unit Faculty of Medicine and Health Sciences University of Zimbabwe Harare Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Coleen K.","family":"Cunningham","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of California Irvine Irvine California USA"},{"name":"Department of Pediatrics Children's Hospital of Orange County Orange California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genevieve G.","family":"Fouda","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Duke University Medical Center Durham North Carolina USA"},{"name":"Duke Human Vaccine Institute Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Landon","family":"Myer","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Biostatistics School of Public Health &amp; Family Medicine University of Cape Town Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milton C.","family":"Weinstein","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management Harvard T.H. 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