Cost-Effectiveness of HIV Treatment in Resource-Poor Settings -- The Case of Cote d'Ivoire

"Cost-Effectiveness of HIV Treatment in Resource-Poor Settings -- The Case of Cote d'Ivoire": Sue Goldie of the Harvard School of Public Health and colleagues used a computer simulation -- which incorporated HIV viral load, CD4+ T cell counts and predictors of HIV progression -- to assess the cost-effectiveness of various HIV treatment strategies in a group of HIV-positive adults in Cote d'Ivoire. The researchers compared long-term economic and clinical outcomes related to not using any treatment, using only antiretroviral therapy, using only prophylaxis therapy and using a combination of antiretroviral and prophylaxis therapies. The study finds that the cost per life year gained for prophylaxis alone is $240; the cost per life year gained for antiretroviral therapy combined with prophylaxis but without CD4+ T cell testing is $620; and the cost per life year gained for antiretroviral therapy combined with prophylaxis and CD4+ T cell testing is $1,180. In addition, the study finds that when antiretroviral and prophylaxis therapies are initiated based on clinical criteria and CD4+ T cell testing, life expectancy rose from 10.7 months -- when antiretroviral therapy and prophylaxis was initiated only on the basis of clinical criteria -- to 45.9 months. The study also finds that life expectancy increased by 30% when second-line antiretroviral therapy was used after first-line therapy failed. The researchers concluded that a strategy that includes prophylaxis and antiretroviral therapies, with the use of "clinical criteria alone or in combination with CD4+ T cell testing to guide the timing of treatment, is an economically attractive health investment in settings with limited resources" (Goldie et al., NEJM, 9/14).

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