OBJECTIVES: The objective of this study is to assess the costs, cost-effectiveness, and HIV epidemic impact of 3 antiretroviral therapy (ART) policy options. STUDY DESIGN: We constructed an epidemiologic model to predict the course of the HIV epidemic in the absence of expanded ART availability. Based on background studies of the willingness to pay for ART among patients with AIDS, of the costs to the government of the alternative treatment interventions, and of ART's likely effects on HIV transmission, we simulated the consequences of 3 possible alternative government ART policies. RESULTS: A program to reduce the negative consequences of the currently unstructured private-sector provision of ART is the most cost-effective of the 3 options at a 10% discount rate and least cost-effective at a 3% rate. The costs and cost-effectiveness of all options are highly sensitive to the effect of ART on condom use. CONCLUSION: The design of ART policy should capitalize on the potential of ART to decrease HIV transmission through institutional arrangements that reward effective prevention programs, thereby raising the likelihood that treatment has beneficial rather than negative external effects.
OBJECTIVES: The objective of this study is to assess the costs, cost-effectiveness, and HIV epidemic impact of 3 antiretroviral therapy (ART) policy options. STUDY DESIGN: We constructed an epidemiologic model to predict the course of the HIV epidemic in the absence of expanded ART availability. Based on background studies of the willingness to pay for ART among patients with AIDS, of the costs to the government of the alternative treatment interventions, and of ART's likely effects on HIV transmission, we simulated the consequences of 3 possible alternative government ART policies. RESULTS: A program to reduce the negative consequences of the currently unstructured private-sector provision of ART is the most cost-effective of the 3 options at a 10% discount rate and least cost-effective at a 3% rate. The costs and cost-effectiveness of all options are highly sensitive to the effect of ART on condom use. CONCLUSION: The design of ART policy should capitalize on the potential of ART to decrease HIV transmission through institutional arrangements that reward effective prevention programs, thereby raising the likelihood that treatment has beneficial rather than negative external effects.
Authors: Elliot Marseille; James G Kahn; Christian Pitter; Rebecca Bunnell; William Epalatai; Emmanuel Jawe; Willy Were; Jonathan Mermin Journal: Appl Health Econ Health Policy Date: 2009 Impact factor: 2.561
Authors: Kenneth A Freedberg; Nagalingeswaran Kumarasamy; Elena Losina; Anitha J Cecelia; Callie A Scott; Nomita Divi; Timothy P Flanigan; Zhigang Lu; Milton C Weinstein; Bingxia Wang; Aylur K Ganesh; Melissa A Bender; Kenneth H Mayer; Rochelle P Walensky Journal: AIDS Date: 2007-07 Impact factor: 4.177
Authors: Vikrant V Sahasrabuddhe; Ramesh A Bhosale; Smita N Joshi; Anita N Kavatkar; Chandraprabha A Nagwanshi; Rohini S Kelkar; Cathy A Jenkins; Bryan E Shepherd; Seema Sahay; Arun R Risbud; Sten H Vermund; Sanjay M Mehendale Journal: PLoS One Date: 2010-01-08 Impact factor: 3.240
Authors: Yesim Tozan; Ariadna Capasso; Sicong Sun; Torsten B Neilands; Christopher Damulira; Flavia Namuwonge; Gertrude Nakigozi; Abel Mwebembezi; Barbara Mukasa; Ozge Sensoy Bahar; Proscovia Nabunya; Claude A Mellins; Mary M McKay; Fred M Ssewamala Journal: J Int AIDS Soc Date: 2021-06 Impact factor: 6.707