Effectiveness and Cost-Effectiveness of Strategies to Expand Antiretroviral Therapy in St. Petersburg, Russia
December 12, 2006
The authors of the current study sought to assess the effectiveness and cost-effectiveness of using highly active antiretroviral therapy (HAART) to treat HIV-infected injection drug users (IDUs) and non-IDUs in Russia.
After developing a dynamic HIV epidemic model for a population of IDUs and non-IDUs in St. Petersburg, the researchers subdivided the adults ages 15 to 49 on the basis of injecting drug use and HIV status. HIV treatment targeted to IDUs and non-IDUs, and untargeted treatment interventions were considered. Measures of health care costs and quality-adjusted life years (QALYs) experienced in the population were recorded, while HIV prevalence, HIV infections avoided, and incremental cost-effectiveness ratios of various HAART strategies were calculated.
Without incremental HAART programs, HIV prevalence among IDUs reached 64 percent and among non-IDUs reached 1.7 percent after 20 years. More than 40,000 HIV infections could be prevented if treatment were targeted to IDUs (75 percent among non-IDUs), adding 650,000 QALYs at a cost of $1,501 per QALY gained. Targeting treatment to non-IDUs would result in fewer than 10,000 infections being prevented, adding 400,000 QALYs at a cost of $2,572 per QALY gained. Untargeted strategies prevented the most infections, adding 950,000 QALYs at a cost of $1,827 per QALY gained. The study results were sensitive to HIV transmission parameters.
"Expanded use of antiretroviral therapy in St. Petersburg, Russia, would generate enormous population-wide health benefits and be economically efficient," the researchers concluded. "Exclusively treating non-IDUs provided the least health benefit, and was the least economically efficient. Our findings highlight the urgency of initiating HAART for both IDUs and non-IDUs in Russia."
11.14.2006; Vol. 20; No. 17: P. 2207-2215; Elisa F. Long; Margaret L. Brandeau; Cristina M. Galvin; Tatyana Vinichenko; Swati P. Tole; Adam Schwartz; Gillian D. Sanders; Douglas K. Owens