OBJECTIVE: Determine the cost-effectiveness of initiating and monitoring highly active antiretroviral therapy (HAART) in developing countries according to developing world versus developed world guidelines. DESIGN: Lifetime Markov model incorporating costs, quality of life, survival, and transmission to sexual contacts. METHODS: We evaluated treating patients with HIV in South Africa according to World Health Organization (WHO) "3 by 5" guidelines (treat CD4 counts <or=200 cells/mm or patients with AIDS, and monitor CD4 cell counts every 6 months) versus modified WHO guidelines that incorporate the following key differences from developed world guidelines: treat CD4 counts <or=350 cells/mm or viral loads >100,000 copies/mL, and monitor CD4 cell counts and viral load every 3 months. RESULTS: Incorporating transmission to partners (excluding indirect costs), treating patients according to developed versus developing world guidelines increased costs by US $11,867 and increased life expectancy by 3.00 quality-adjusted life-years (QALYs), for an incremental cost-effectiveness of $3956 per QALY. Including indirect costs, over the duration of the model, there are net cost savings to the economy of $39.4 billion, with increased direct medical costs of $60.5 billion offset by indirect cost savings of $99.9 billion. CONCLUSIONS: Treating patients with HIV according to developed versus developing world guidelines is highly cost-effective and may result in substantial long-term savings.
OBJECTIVE: Determine the cost-effectiveness of initiating and monitoring highly active antiretroviral therapy (HAART) in developing countries according to developing world versus developed world guidelines. DESIGN: Lifetime Markov model incorporating costs, quality of life, survival, and transmission to sexual contacts. METHODS: We evaluated treating patients with HIV in South Africa according to World Health Organization (WHO) "3 by 5" guidelines (treat CD4 counts <or=200 cells/mm or patients with AIDS, and monitor CD4 cell counts every 6 months) versus modified WHO guidelines that incorporate the following key differences from developed world guidelines: treat CD4 counts <or=350 cells/mm or viral loads >100,000 copies/mL, and monitor CD4 cell counts and viral load every 3 months. RESULTS: Incorporating transmission to partners (excluding indirect costs), treating patients according to developed versus developing world guidelines increased costs by US $11,867 and increased life expectancy by 3.00 quality-adjusted life-years (QALYs), for an incremental cost-effectiveness of $3956 per QALY. Including indirect costs, over the duration of the model, there are net cost savings to the economy of $39.4 billion, with increased direct medical costs of $60.5 billion offset by indirect cost savings of $99.9 billion. CONCLUSIONS: Treating patients with HIV according to developed versus developing world guidelines is highly cost-effective and may result in substantial long-term savings.
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: Paul K Drain; Jienchi Dorward; Andrew Bender; Lorraine Lillis; Francesco Marinucci; Jilian Sacks; Anna Bershteyn; David S Boyle; Jonathan D Posner; Nigel Garrett Journal: Clin Microbiol Rev Date: 2019-05-15 Impact factor: 26.132
Authors: Rory Leisegang; Gary Maartens; Michael Hislop; Leon Regensberg; Susan Cleary Journal: BMC Health Serv Res Date: 2010-07-02 Impact factor: 2.655