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Effectiveness and cost-effectiveness of strategies to expand antiretroviral therapy in St. Petersburg, Russia

Long, Elisa Fa; Brandeau, Margaret La; Galvin, Cristina Mb; Vinichenko, Tatyanab; Tole, Swati Pb; Schwartz, Adamb; Sanders, Gillian Dc; Owens, Douglas Kb,d

doi: 10.1097/QAD.0b013e328010c7d0
Epidemiology and Social

Objective: To assess the effectiveness and cost-effectiveness of treating HIV-infected injection drug users (IDUs) and non-IDUs in Russia with highly active antiretroviral therapy HAART.

Design and methods: A dynamic HIV epidemic model was developed for a population of IDUs and non-IDUs. The location for the study was St. Petersburg, Russia. The adult population aged 15 to 49 years was subdivided on the basis of injection drug use and HIV status. HIV treatment targeted to IDUs and non-IDUs, and untargeted treatment interventions were considered. Health care costs and quality-adjusted life years (QALYs) experienced in the population were measured, and HIV prevalence, HIV infections averted, and incremental cost-effectiveness ratios of different HAART strategies were calculated.

Results: With no incremental HAART programs, HIV prevalence reached 64% among IDUs and 1.7% among non-IDUs after 20 years. If treatment were targeted to IDUs, over 40 000 infections would be prevented (75% among non-IDUs), adding 650 000 QALYs at a cost of US$ 1501 per QALY gained. If treatment were targeted to non-IDUs, fewer than 10 000 infections would be prevented, adding 400 000 QALYs at a cost of US$ 2572 per QALY gained. Untargeted strategies prevented the most infections, adding 950 000 QALYs at a cost of US$ 1827 per QALY gained. Our results were sensitive to HIV transmission parameters.

Conclusions: Expanded use of antiretroviral therapy in St. Petersburg, Russia would generate enormous population-wide health benefits and be economically efficient. 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.

From the aDepartment of Management Science and Engineering, California, USA

bCenter for Primary Care and Outcomes Research, Stanford University, Stanford, California, USA

cDuke Clinical Research Institute, Duke University, Durham, North Carolina

dDepartment of Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.

Received 24 January, 2006

Revised 28 July, 2006

Accepted 12 September, 2006

Correspondence to Elisa F. Long, Stanford University, 467 Terman Engineering Center, Stanford, California 94305, USA. E-mail:

© 2006 Lippincott Williams & Wilkins, Inc.