Ethan D Borre1,2, Emily P Hyle1,3, A David Paltiel4, Anne M Neilan1,3,5, Paul E Sax6, Kenneth A Freedberg1,2,3,7,8,9, Milton C Weinstein9, Rochelle P Walensky1,2,3,6,7. 1. Medical Practice Evaluation Center. 2. Division of General Internal Medicine. 3. Division of Infectious Diseases. 4. Yale School of Public Health, New Haven, Connecticut. 5. Department of Pediatrics, Massachusetts General Hospital. 6. Division of Infectious Diseases, Brigham and Women's Hospital. 7. Harvard University Center for AIDS Research, Harvard Medical School. 8. Department of Epidemiology, Boston University School of Public Health. 9. Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Abstract
Background: The US National HIV/AIDS Strategy (NHAS) aims for 72% (90% diagnosed times 80% of those virally suppressed) viral suppression among persons with human immunodeficiency virus (HIV) by 2020. We examined the clinical and economic impact of reaching this target, in the general US population and among black men who have sex with men (MSM), the group with the highest HIV prevalence. Methods: Using a mathematical simulation, we project the 5- and 20-year clinical outcomes, costs, and incremental cost-effectiveness ratios for (1) Current Pace of detection, linkage, retention, and virologic suppression and (2) NHAS investments in expanded testing ($24-$74 per test) and adherence ($400 per person-year), calibrated to achieve 72% suppression by 2020. We examined alternative rates of testing, retention, and suppression and the efficacy and cost of adherence interventions. Results: Compared with Current Pace over 20 years, NHAS averted 280000 HIV transmissions (80000 in black MSM) and 199000 (45000) deaths and saved 2138000 (453000) years of life, while increasing costs by 23%. The incremental cost-effectiveness ratio for NHAS compared with Current Pace was $68900 per quality-adjusted life-year ($38300 for black MSM) and was most sensitive to antiretroviral therapy costs. Conclusions: Reaching NHAS targets would yield substantial clinical benefits and be cost-effective in both the general US and black MSM populations.
Background: The US National HIV/AIDS Strategy (NHAS) aims for 72% (90% diagnosed times 80% of those virally suppressed) viral suppression among persons with human immunodeficiency virus (HIV) by 2020. We examined the clinical and economic impact of reaching this target, in the general US population and among black men who have sex with men (MSM), the group with the highest HIV prevalence. Methods: Using a mathematical simulation, we project the 5- and 20-year clinical outcomes, costs, and incremental cost-effectiveness ratios for (1) Current Pace of detection, linkage, retention, and virologic suppression and (2) NHAS investments in expanded testing ($24-$74 per test) and adherence ($400 per person-year), calibrated to achieve 72% suppression by 2020. We examined alternative rates of testing, retention, and suppression and the efficacy and cost of adherence interventions. Results: Compared with Current Pace over 20 years, NHAS averted 280000 HIV transmissions (80000 in black MSM) and 199000 (45000) deaths and saved 2138000 (453000) years of life, while increasing costs by 23%. The incremental cost-effectiveness ratio for NHAS compared with Current Pace was $68900 per quality-adjusted life-year ($38300 for black MSM) and was most sensitive to antiretroviral therapy costs. Conclusions: Reaching NHAS targets would yield substantial clinical benefits and be cost-effective in both the general US and black MSM populations.
Authors: Maria J Wawer; Ronald H Gray; Nelson K Sewankambo; David Serwadda; Xianbin Li; Oliver Laeyendecker; Noah Kiwanuka; Godfrey Kigozi; Mohammed Kiddugavu; Thomas Lutalo; Fred Nalugoda; Fred Wabwire-Mangen; Mary P Meehan; Thomas C Quinn Journal: J Infect Dis Date: 2005-03-30 Impact factor: 5.226
Authors: Jens D Lundgren; Abdel G Babiker; Fred Gordin; Sean Emery; Birgit Grund; Shweta Sharma; Anchalee Avihingsanon; David A Cooper; Gerd Fätkenheuer; Josep M Llibre; Jean-Michel Molina; Paula Munderi; Mauro Schechter; Robin Wood; Karin L Klingman; Simon Collins; H Clifford Lane; Andrew N Phillips; James D Neaton Journal: N Engl J Med Date: 2015-07-20 Impact factor: 91.245
Authors: Mary K Irvine; Stephanie A Chamberlin; Rebekkah S Robbins; Julie E Myers; Sarah L Braunstein; Beau J Mitts; Graham A Harriman; Fabienne Laraque; Denis Nash Journal: Clin Infect Dis Date: 2014-10-09 Impact factor: 9.079
Authors: Ignacio Pérez Valero; Juan Pasquau; Rafael Rubio; Antonio Ribero; Jose Santos; Jesus Sanz; Ana Mariño; Manel Crespo; Jose Hernandez; Jose Antonio Iribarren; Felix Gutierrez; Alberto Terron; Herminia Esteban; Jose Antonio Pérez-Molina Journal: J Int AIDS Soc Date: 2014-11-02 Impact factor: 5.396
Authors: Peter F Rebeiro; Stephen J Gange; Michael A Horberg; Alison G Abraham; Sonia Napravnik; Hasina Samji; Baligh R Yehia; Keri N Althoff; Richard D Moore; Mari M Kitahata; Timothy R Sterling; Frank C Curriero Journal: PLoS One Date: 2016-01-11 Impact factor: 3.240
Authors: Kate Buchacz; Emma L Frazier; H Irene Hall; Rachel Hart; Ping Huang; Dana Franklin; Xiaohong Hu; Frank J Palella; Joan S Chmiel; Richard M Novak; Kathy Wood; Bienvenido Yangco; Carl Armon; John T Brooks; Jacek Skarbinski Journal: Open AIDS J Date: 2015-12-07
Authors: Ole F Norheim; Rob Baltussen; Mira Johri; Dan Chisholm; Erik Nord; DanW Brock; Per Carlsson; Richard Cookson; Norman Daniels; Marion Danis; Marc Fleurbaey; Kjell A Johansson; Lydia Kapiriri; Peter Littlejohns; Thomas Mbeeli; Krishna D Rao; Tessa Tan-Torres Edejer; Dan Wikler Journal: Cost Eff Resour Alloc Date: 2014-08-29
Authors: Pooyan Kazemian; Sydney Costantini; Anne M Neilan; Stephen C Resch; Rochelle P Walensky; Milton C Weinstein; Kenneth A Freedberg Journal: J Biomed Inform Date: 2020-06-08 Impact factor: 6.317
Authors: Emily P Hyle; Justine A Scott; Paul E Sax; Lucia R I Millham; Caitlin M Dugdale; Milton C Weinstein; Kenneth A Freedberg; Rochelle P Walensky Journal: Clin Infect Dis Date: 2020-03-17 Impact factor: 9.079
Authors: Bohdan Nosyk; Xiao Zang; Emanuel Krebs; Benjamin Enns; Jeong E Min; Czarina N Behrends; Carlos Del Rio; Julia C Dombrowski; Daniel J Feaster; Matthew Golden; Brandon D L Marshall; Shruti H Mehta; Lisa R Metsch; Ankur Pandya; Bruce R Schackman; Steven Shoptaw; Steffanie A Strathdee Journal: Lancet HIV Date: 2020-03-05 Impact factor: 12.767
Authors: Lucia R I Millham; Justine A Scott; Paul E Sax; Fatma M Shebl; Krishna P Reddy; Elena Losina; Rochelle P Walensky; Kenneth A Freedberg Journal: J Acquir Immune Defic Syndr Date: 2020-02-01 Impact factor: 3.771
Authors: Anne M Neilan; Frances Lu; Kelly A Gebo; Rebeca Diaz-Reyes; Mingshu Huang; Robert A Parker; Brad Karalius; Kunjal Patel; Cindy Voss; Andrea L Ciaranello; Allison L Agwu Journal: J Acquir Immune Defic Syndr Date: 2020-04-01 Impact factor: 3.771
Authors: Emanuel Krebs; Xiao Zang; Benjamin Enns; Jeong E Min; Czarina N Behrends; Carlos Del Rio; Julia C Dombrowski; Daniel J Feaster; Kelly A Gebo; Matthew Golden; Brandon D L Marshall; Lisa R Metsch; Bruce R Schackman; Steven Shoptaw; Steffanie A Strathdee; Bohdan Nosyk Journal: AIDS Date: 2020-03-01 Impact factor: 4.632