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Cost-Effectiveness of Alternative Strategies for Initiating and Monitoring Highly Active Antiretroviral Therapy in the Developing World

Vijayaraghavan, Arthi MS*; Efrusy, Molly Bates MPH*; Mazonson, Peter D MD, MBA*; Ebrahim, Osman MD, PhD; Sanne, Ian M MD; Santas, Christopher C MBA*

JAIDS Journal of Acquired Immune Deficiency Syndromes: September 1st, 2007 - Volume 46 - Issue 1 - p 91-100
doi: 10.1097/QAI.0b013e3181342564
Epidemiology and Social Science

Objective: Determine the cost-effectiveness of initiating and monitoring highly active antiretroviral therapy (HAART) in developing countries according to developing world versus developed world guidelines.

Design: Lifetime Markov model incorporating costs, quality of life, survival, and transmission to sexual contacts.

Methods: We evaluated treating patients with HIV in South Africa according to World Health Organization (WHO) “3 by 5” guidelines (treat CD4 counts ≤200 cells/mm3 or patients with AIDS, and monitor CD4 cell counts every 6 months) versus modified WHO guidelines that incorporate the following key differences from developed world guidelines: treat CD4 counts ≤350 cells/mm3 or viral loads >100,000 copies/mL, and monitor CD4 cell counts and viral load every 3 months.

Results: Incorporating transmission to partners (excluding indirect costs), treating patients according to developed versus developing world guidelines increased costs by US $11,867 and increased life expectancy by 3.00 quality-adjusted life-years (QALYs), for an incremental cost-effectiveness of $3956 per QALY. Including indirect costs, over the duration of the model, there are net cost savings to the economy of $39.4 billion, with increased direct medical costs of $60.5 billion offset by indirect cost savings of $99.9 billion.

Conclusions: Treating patients with HIV according to developed versus developing world guidelines is highly cost-effective and may result in substantial long-term savings.

From *Mosaic Health Care Consultants, Larkspur, CA; †Brenthurst Clinic, Parktown, Johannesburg, South Africa; and ‡Clinical HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa

Received for publication October 10, 2006; accepted June 5, 2007.

Funded by an unrestricted educational grant from Roche Molecular Systems, Pleasanton, CA.

Presented at the International AIDS Conference, Toronto, Ontario, Canada, August 15, 2006.

All authors have received honoraria or consultancy fees from Roche Molecular Systems.

Reprints: Arthi Vijayaraghavan, MS, 15 Hillcrest Avenue, Larkspur, CA 94939 (e-mail: vijayaraghavan_arthi@yahoo.com).

© 2007 Lippincott Williams & Wilkins, Inc.