BACKGROUND: India has more than 5.7 million people infected with human immunodeficiency virus (HIV). In 2004, the Indian government began providing antiretroviral therapy (ART), and there are now an estimated 56 500 people receiving ART. OBJECTIVE: To project the life expectancy, cost, and cost-effectiveness associated with different strategies for using ART in India, to inform treatment programs. METHODS: We utilized an HIV disease simulation model, incorporating data on natural history, treatment efficacy, and costs of care from India. Input parameters for the simulated cohort included mean age 32.6 years and mean CD4 count 318 cells/microl (SD 291 cells/microl). We examined different criteria for starting and stopping ART with a first-line regimen of stavudine/lamivudine/nevirapine, and the impact of a second-line protease-inhibitor-based regimen. Cost-effectiveness in US dollars per year of life saved (US$/YLS) was compared incrementally among alternative starting, sequencing, and stopping criteria. RESULTS: Discounted (undiscounted) mean survival ranged from 34.5 (37.5) months with no ART to 64.7 (73.6) months with one line of therapy initiated at CD4 <350 cells/microl, to 88.9 (106.5) months with two lines of therapy initiated at CD4 <350 cells/microl. Lifetime medical costs ranged from US$530 (no ART) to US$5430 (two ART regimens) per person. With one line of therapy, the incremental cost-effectiveness ratios ranged from US$430/YLS to US$550/YLS as the CD4 starting criterion was increased from CD4 <250 cells/microl to <350 cells/microl. Use of two lines of therapy had an incremental cost-effectiveness ratio of US$1880/YLS compared with the use of first-line therapy alone. Results were sensitive to the costs of second-line therapy and criteria for stopping therapy. CONCLUSIONS: In India, antiretroviral therapy will lead to major survival benefits and is cost-effective by World Health Organization criteria. The availability of second-line regimens will further increase survival, but their cost-effectiveness depends on their relative cost compared with first-line regimens.
BACKGROUND: India has more than 5.7 million people infected with human immunodeficiency virus (HIV). In 2004, the Indian government began providing antiretroviral therapy (ART), and there are now an estimated 56 500 people receiving ART. OBJECTIVE: To project the life expectancy, cost, and cost-effectiveness associated with different strategies for using ART in India, to inform treatment programs. METHODS: We utilized an HIV disease simulation model, incorporating data on natural history, treatment efficacy, and costs of care from India. Input parameters for the simulated cohort included mean age 32.6 years and mean CD4 count 318 cells/microl (SD 291 cells/microl). We examined different criteria for starting and stopping ART with a first-line regimen of stavudine/lamivudine/nevirapine, and the impact of a second-line protease-inhibitor-based regimen. Cost-effectiveness in US dollars per year of life saved (US$/YLS) was compared incrementally among alternative starting, sequencing, and stopping criteria. RESULTS: Discounted (undiscounted) mean survival ranged from 34.5 (37.5) months with no ART to 64.7 (73.6) months with one line of therapy initiated at CD4 <350 cells/microl, to 88.9 (106.5) months with two lines of therapy initiated at CD4 <350 cells/microl. Lifetime medical costs ranged from US$530 (no ART) to US$5430 (two ART regimens) per person. With one line of therapy, the incremental cost-effectiveness ratios ranged from US$430/YLS to US$550/YLS as the CD4 starting criterion was increased from CD4 <250 cells/microl to <350 cells/microl. Use of two lines of therapy had an incremental cost-effectiveness ratio of US$1880/YLS compared with the use of first-line therapy alone. Results were sensitive to the costs of second-line therapy and criteria for stopping therapy. CONCLUSIONS: In India, antiretroviral therapy will lead to major survival benefits and is cost-effective by World Health Organization criteria. The availability of second-line regimens will further increase survival, but their cost-effectiveness depends on their relative cost compared with first-line regimens.
Authors: M C Weinstein; S J Goldie; E Losina; C J Cohen; J D Baxter; H Zhang; A D Kimmel; K A Freedberg Journal: Ann Intern Med Date: 2001-03-20 Impact factor: 25.391
Authors: Rochelle P Walensky; Milton C Weinstein; Yazdan Yazdanpanah; Elena Losina; Lauren M Mercincavage; Siaka Touré; Nomita Divi; Xavier Anglaret; Sue J Goldie; Kenneth A Freedberg Journal: AIDS Date: 2007-05-11 Impact factor: 4.177
Authors: K A Freedberg; E Losina; M C Weinstein; A D Paltiel; C J Cohen; G R Seage; D E Craven; H Zhang; A D Kimmel; S J Goldie Journal: N Engl J Med Date: 2001-03-15 Impact factor: 91.245
Authors: Benjamin Young; Margaret A Fischl; Helene M Wilson; Tyler S Finn; Erin H Jensen; Mark J DiNubile; Robert K Zeldin Journal: J Acquir Immune Defic Syndr Date: 2002-12-15 Impact factor: 3.731
Authors: Yazdan Yazdanpanah; Elena Losina; Xavier Anglaret; Sue J Goldie; Rochelle P Walensky; Milton C Weinstein; Siaka Toure; Heather E Smith; Jonathan E Kaplan; Kenneth A Freedberg Journal: AIDS Date: 2005-08-12 Impact factor: 4.177
Authors: Sue J Goldie; Jonathan E Kaplan; Elena Losina; Milton C Weinstein; A David Paltiel; George R Seage; Donald E Craven; April D Kimmel; Hong Zhang; Calvin J Cohen; Kenneth A Freedberg Journal: Arch Intern Med Date: 2002-04-22
Authors: N Kumarasamy; Suniti Solomon; Timothy P Flanigan; R Hemalatha; S P Thyagarajan; Kenneth H Mayer Journal: Clin Infect Dis Date: 2002-12-09 Impact factor: 9.079
Authors: Jialun Zhou; N Kumarasamy; Rossana Ditangco; Adeeba Kamarulzaman; Christopher K C Lee; Patrick C K Li; Nicholas I Paton; Praphan Phanuphak; Sanjay Pujari; Asda Vibhagool; Wing-Wai Wong; Fujie Zhang; John Chuah; Kevin R Frost; David A Cooper; Matthew G Law Journal: J Acquir Immune Defic Syndr Date: 2005-02-01 Impact factor: 3.771
Authors: Serena P Koenig; Bruce R Schackman; Cynthia Riviere; Paul Leger; Macarthur Charles; Patrice Severe; Charlene Lastimoso; Nicole Colucci; Jean W Pape; Daniel W Fitzgerald Journal: Clin Infect Dis Date: 2010-09-01 Impact factor: 9.079
Authors: April D Kimmel; Milton C Weinstein; Xavier Anglaret; Sue J Goldie; Elena Losina; Yazdan Yazdanpanah; Eugène Messou; Kara L Cotich; Rochelle P Walensky; Kenneth A Freedberg Journal: J Acquir Immune Defic Syndr Date: 2010-07 Impact factor: 3.731
Authors: Ryuichi Komatsu; Eline L Korenromp; Daniel Low-Beer; Catherine Watt; Christopher Dye; Richard W Steketee; Bernard L Nahlen; Rob Lyerla; Jesus M Garcia-Calleja; John Cutler; Bernhard Schwartländer Journal: BMC Infect Dis Date: 2010-04-30 Impact factor: 3.090