Vijayaraghavan A., Efrusy M.B., Mazonson P.D., Ebrahim O., Sanne I.M., Santas C.C.
Mosaic Health Care Consultants, Larkspur, CA, United States; Brenthurst Clinic, Parktown, Johannesburg, South Africa; Clinical HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa; 15 Hillcrest Avenue, Larkspur, CA 94939, United States
Vijayaraghavan, A., Mosaic Health Care Consultants, Larkspur, CA, United States, 15 Hillcrest Avenue, Larkspur, CA 94939, United States; Efrusy, M.B., Mosaic Health Care Consultants, Larkspur, CA, United States; Mazonson, P.D., Mosaic Health Care Consultants, Larkspur, CA, United States; Ebrahim, O., Brenthurst Clinic, Parktown, Johannesburg, South Africa; Sanne, I.M., Clinical HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Santas, C.C., Mosaic Health Care Consultants, Larkspur, CA, United States
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/mm 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/mm 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. © 2007 Lippincott Williams & Wilkins, Inc.
antiretrovirus agent; didanosine; efavirenz; lamivudine; lopinavir plus ritonavir; nevirapine; stavudine; tenofovir; acquired immune deficiency syndrome; adolescent; adult; article; CD4 lymphocyte count; controlled study; cost; cost control; cost effectiveness analysis; developing country; economic aspect; female; highly active antiretroviral therapy; human; human cell; Human immunodeficiency virus infection; life expectancy; major clinical study; male; priority journal; probability; quality adjusted life year; quality of life; sexual transmission; sexuality; South Africa; survival; virus load; world health organization; Adult; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Cost-Benefit Analysis; Developing Countries; Health Care Costs; HIV Infections; Humans; Markov Chains; Models, Economic; Monte Carlo Method; Practice Guidelines as Topic; Sensitivity and Specificity; South Africa; United States; United States Dept. of Health and Human Services; World Health Organization