Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States; Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, KwaZulu-Natal, South Africa; Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, GA, United States
Bärnighausen, T., Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States, Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, KwaZulu-Natal, South Africa; Salomon, J.A., Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States; Sangrujee, N., Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, GA, United States
Meyer-Rath and Over assert in another article in the July 2012 PLoS Medicine Collection, "Investigating the Impact of Treatment on New HIV Infections", that economic evaluations of antiretroviral therapy (ART) in currently existing programs and in HIV treatment as prevention (TasP) programs should use cost functions that capture cost dependence on a number of factors, such as scale and scope of delivery, health states, ART regimens, health workers' experience, patients' time on treatment, and the distribution of delivery across public and private sectors. We argue that for particular evaluation purposes (e.g., to establish the social value of TasP) and from particular perspectives (e.g., national health policy makers) less detailed cost functions may be sufficient. We then extend the discussion of economic evaluation of TasP, describing why ART outcomes and costs assessed in currently existing programs are unlikely to be generalizable to TasP programs for several fundamental reasons. First, to achieve frequent, widespread HIV testing and high uptake of ART immediately following an HIV diagnosis, TasP programs will require components that are not present in current ART programs and whose costs are not included in current estimates. Second, the early initiation of ART under TasP will change not only patients' disease courses and treatment experiences-which can affect behaviors that determine clinical treatment success, such as ART adherence and retention-but also quality of life and economic outcomes for HIV-infected individuals. Third, the preventive effects of TasP are likely to alter the composition of the HIV-infected population over time, changing its biological and behavioral characteristics and leading to different costs and outcomes for ART.
antiretrovirus agent; anti human immunodeficiency virus agent; article; CD4 lymphocyte count; cost effectiveness analysis; disease course; economic development; economic evaluation; health care policy; health program; HIV test; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; incidence; mortality; quality of life; treatment outcome; virus transmission; cost; economics; evaluation; highly active antiretroviral therapy; Human immunodeficiency virus infection; review; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Costs and Cost Analysis; Evaluation Studies as Topic; HIV Infections; Humans; Treatment Outcome