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Prevention/Epidemiology

Cost-Effectiveness of HIV Monitoring Strategies in Resource-Limited Settings

October 7, 2008

"Although the number of persons receiving highly active antiretroviral therapy (HAART) in low- and middle-income countries has increased dramatically, optimal disease management is not well-defined," wrote the authors of the current study.

A model was developed to compare the costs and benefits of three types of HIV monitoring strategies: symptom-based strategies, CD4-based strategies, and CD4 counts plus viral load strategies for initiating, switching and stopping HAART. A cost-effectiveness analysis was performed using clinical and cost data from southern Africa. All assumptions were tested in sensitivity analyses.

Compared with the symptom-based approaches, monitoring CD4 counts at six month intervals and initiating treatment at a threshold of 200/µL was associated with a gain in life expectancy of 6.5 months (61.9 months vs. 68.4 months) and a discounted lifetime cost savings of $464 per person ($4,069 vs. $3,605, discounted 2007 US dollars). CD4-based strategies that started treatment at the higher threshold of 350/µL provided an additional gain in life expectancy of 5.3 months at a cost-effectiveness of $107 per life-year gained compared with a threshold of 200/µL. Monitoring viral load with CD4 was more costly than monitoring CD4 counts alone, added 2.0 months of life, and had an incremental cost-effectiveness ratio of $5,414 per life-year gained relative to monitoring of CD4 counts. Sensitivity analyses showed the cost savings from CD4 count monitoring, compared with the symptom-based approaches, was sensitive to cost of inpatient care, and the cost-effectiveness of viral load monitoring was influenced by the per test costs and rates of virologic failure.

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"Use of CD4 monitoring and early initiation of HAART in southern Africa provides large health benefits relative to symptom-based approaches for HAART management," the authors concluded. "In southern African countries with relatively high costs of hospitalization, CD4 monitoring would likely reduce total health care expenditures. The cost-effectiveness of viral load monitoring depends on test prices and rates of virologic failure."

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Adapted from:
Archives of Internal Medicine
09.22.2008; Eran Bendavid, M.D.; Sean D. Young, M.S.; David A. Katzenstein, M.D.; Ahmed M. Bayoumi, M.D., M.Sc.; Gillian D. Sanders, Ph.D.; Douglas K. Owens, M.D., M.S.


  
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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.
 
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