Cost-Effectiveness of HIV Treatment in Resource-Poor Settings -- The Case of Côte d'Ivoire
September 28, 2006
"As antiretroviral therapy is increasingly used in settings with limited resources, key questions about the timing of treatment and use of diagnostic tests to guide clinical decisions must be addressed," the authors wrote.
In the current study, they addressed the cost-effectiveness of treatment strategies for a cohort of HIV-positive adults in Ivory Coast. Study subjects had a mean age of 33 years; CD4 cell count of 331 per cubic millimeter; and an HIV RNA level of 5.3 log copies per milliliter. Using a computer-based simulation model incorporating CD4 cell count and HIV RNA level as predictors of disease progression, they compared the long-term clinical and economic outcomes of several strategies: no treatment; trimethoprim-sulfamethoxazole prophylaxis alone; antiretroviral therapy alone; and prophylaxis with antiretroviral therapy.
The researchers found that undiscounted gains in life expectancy ranged from 10.7 months with antiretroviral therapy and prophylaxis begun on the basis of clinical criteria to 45.9 months with antiretroviral therapy and prophylaxis begun on the basis of CD4 testing and clinical criteria as compared to trimethoprim-sulfamethoxazole prophylaxis alone. In 2002 US dollars, the incremental cost per year of life gained was $240 for prophylaxis only; $620 for antiretroviral therapy and prophylaxis without CD4 testing; and $1,180 for antiretroviral therapy and prophylaxis with CD4 testing, each compared with the next least expensive strategy.
"None of the strategies that used antiretroviral therapy alone were as cost-effective as those that also used trimethoprim-sulfamethoxazole prophylaxis," the researchers reported. "Life expectancy was increased by 30% with use of a second line of antiretroviral therapy after failure of the first-line regimen."
The prophylaxis plus antiretroviral therapy approach, with the use of clinical criteria alone or in combination with CD4 testing to guide the timing of treatment, "is an economically attractive health investment in settings with limited resources," the researchers concluded.
New England Journal of Medicine
09.14.2006; Vol. 355; No. 11: P. 1141-1153; Sue J. Goldie, M.D., M.P.H.; Yazdan Yazdanpanah, M.D., Ph.D.; Elena Losina, Ph.D.; Milton C. Weinstein, Ph.D.; Xavier Anglaret, M.D., Ph.D.; Rochelle P. Walensky, M.D., M.P.H.; Heather E. Hsu, A.B.; April Kimmel, M.S.; Charles Holmes, M.D., M.P.H.; Jonathan E. Kaplan, M.D.; Kenneth A. Freedberg
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.