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Expanding access to HAART: a cost-effective approach for treating and preventing HIV

Johnston, Karissa Ma; Levy, Adrian Rb; Lima, Viviane Dc; Hogg, Robert Sc; Tyndall, Mark Wc; Gustafson, Pauld; Briggs, Andrewe; Montaner, Julio Sc

doi: 10.1097/QAD.0b013e32833af85d
Epidemiology and Social

Objective: HIV continues to present a substantial global health burden. Given the high direct medical costs associated with the disease, prevention of new transmission is an important element in limiting economic burden. In addition to providing therapeutic benefit, treatment with HAART has potential to prevent transmission of HIV. The objective in this study was to perform an economic evaluation of the incremental net benefit associated with an intervention to expand treatment with HAART in British Columbia, Canada.

Design: A mathematical model describing transmission of HIV, integrated with a microsimulation model describing the clinical and economic course of HIV.

Methods: The primary outcome was the incremental net benefit of expanding treatment with HAART from 50 to 75% of clinically eligible individuals in British Columbia, assuming a willingness-to-pay threshold of US$ 50 000 per quality-adjusted life year. Direct medical costs included were antiretroviral and nonantiretroviral medications, hospitalizations, physician visits, and laboratory tests. The mathematical and microsimulation models were based on patient characteristics observed in British Columbia. Longitudinal data described health services utilization, clinical progression, and survival for all individuals receiving treatment for HIV in British Columbia.

Results: Over 30 years, the HAART expansion scenario was associated with a net benefit of US$ 900 million (95% confidence interval US$ 493 million to 1.45 billion).

Conclusion: Increasing the HAART treatment rate from 50 to 75% of clinically eligible individuals in British Columbia appears to be a cost-effective strategy based on this model. These cost-effectiveness results are consistent with public health objectives: all individuals who are eligible for an established life-saving treatment should receive it.

aSchool of Population and Public Health, University of British ColumbiaVancouver, British Columbia, Canada

bCommunity Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada

cBritish Columbia Centre for Excellence in HIV/AIDS Research, Vancouver, British Columbia, Canada

dDepartment of Statistics, University of British Columbia, Vancouver, British Columbia, Canada

ePublic Health and Health Policy, University of Glasgow, Glasgow, Scotland, UK.

Received 16 February, 2010

Revised 8 April, 2010

Accepted 14 April, 2010

Correspondence to Dr Julio S. Montaner, Room 667, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.