Health benefits, costs, and cost-effectiveness of earlier eligibility for adult antiretroviral therapy and expanded treatment coverage: a combined analysis of 12 mathematical models
| Autor: | Till Bärnighausen, Chaitra Gopalappa, Quang D. Pham, Ted Cohen, David Wilson, Lei Zhang, Meg Doherty, Nicolas A Menzies, Joshua A. Salomon, Marie-Claude Boily, H Prudden, Brooke E Nichols, Valentina Cambiano, Andrew N. Phillips, Nathan Shaffer, Fern Terris-Prestholt, Sharmistha Mishra, Anne Cori, John M. Blandford, Anna Bershteyn, Timothy B. Hallett, Michael Pickles, Leonid Chindelevitch, Richard G. White, Bradley G. Wagner, Daniel J. Klein, John Stover, Jeffrey W. Eaton, Lucy Platt, Nalinee Sangrujee, Carel Pretorius, Elisa Mountain, Peter J. Dodd, David A. M. C. van de Vijver, Evelinn Mikkelsen, Philippa Easterbrook, Jens D Lundgren, Natasha K. Martin, Jan A. C. Hontelez, Stewart T. Chang, Gesine Meyer-Rath, Salal Humair, Paul Revill, Peter Vickerman, Sake J. de Vlas, Kate M. Mitchell, Michelle Remme, David E. Bloom, Gottfried Hirnschall, Cliff C. Kerr, Christophe Fraser, Roel Bakker |
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| Přispěvatelé: | Medical Research Council (MRC), Public Health, Virology, Clinical Genetics |
| Rok vydání: | 2014 |
| Předmět: |
Gerontology
Male Comparative Effectiveness Research IMPACT Cost effectiveness Cost-Benefit Analysis Eligibility Determination HIV Infections South Africa Theoretical Models Antiretroviral Therapy Highly Active INFECTION Medicine health care economics and organizations Public Environmental & Occupational Health RISK education.field_of_study Cost–benefit analysis lcsh:Public aspects of medicine General Medicine Health Care Costs Health Services SOUTH-AFRICA PREVALENCE 3. Good health Vietnam 6.1 Pharmaceuticals Public Health and Health Services HIV/AIDS SEX Female Quality-Adjusted Life Years Infection Life Sciences & Biomedicine ART 0605 Microbiology Marginal cost Adult Population Antiretroviral Therapy Developing country India Zambia Microbiology Article 1117 Public Health and Health Services Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] SDG 3 - Good Health and Well-being Clinical Research parasitic diseases Humans Highly Active education Science & Technology business.industry Prevention Evaluation of treatments and therapeutic interventions HIV PREVENTION lcsh:RA1-1270 Models Theoretical Quality-adjusted life year CD4 Lymphocyte Count Good Health and Well Being lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4] Cost Effectiveness Research SETTINGS Expanded access business Demography |
| Zdroj: | Lancet Global Health, 2, 1, pp. e23-34 The Lancet Global Health BASE-Bielefeld Academic Search Engine The Lancet Global Health, Vol 2, Iss 1, Pp e23-e34 (2014) E34 E23 The Lancet Global Health, 2(1), E23-E34. Elsevier Lancet Global Health, 2, e23-34 The Lancet Global Health; Vol 2 The Lancet. Global health, vol 2, iss 1 |
| ISSN: | 2214-109X |
| DOI: | 10.1016/s2214-109x(13)70172-4 |
| Popis: | Contains fulltext : 138145.pdf (Publisher’s version ) (Open Access) BACKGROUND: New WHO guidelines recommend initiation of antiretroviral therapy for HIV-positive adults with CD4 counts of 500 cells per muL or less, a higher threshold than was previously recommended. Country decision makers have to decide whether to further expand eligibility for antiretroviral therapy accordingly. We aimed to assess the potential health benefits, costs, and cost-effectiveness of various eligibility criteria for adult antiretroviral therapy and expanded treatment coverage. METHODS: We used several independent mathematical models in four settings-South Africa (generalised epidemic, moderate antiretroviral therapy coverage), Zambia (generalised epidemic, high antiretroviral therapy coverage), India (concentrated epidemic, moderate antiretroviral therapy coverage), and Vietnam (concentrated epidemic, low antiretroviral therapy coverage)-to assess the potential health benefits, costs, and cost-effectiveness of various eligibility criteria for adult antiretroviral therapy under scenarios of existing and expanded treatment coverage, with results projected over 20 years. Analyses assessed the extension of eligibility to include individuals with CD4 counts of 500 cells per muL or less, or all HIV-positive adults, compared with the previous (2010) recommendation of initiation with CD4 counts of 350 cells per muL or less. We assessed costs from a health-system perspective, and calculated the incremental cost (in US$) per disability-adjusted life-year (DALY) averted to compare competing strategies. Strategies were regarded very cost effective if the cost per DALY averted was less than the country's 2012 per-head gross domestic product (GDP; South Africa: $8040; Zambia: $1425; India: $1489; Vietnam: $1407) and cost effective if the cost per DALY averted was less than three times the per-head GDP. FINDINGS: In South Africa, the cost per DALY averted of extending eligibility for antiretroviral therapy to adult patients with CD4 counts of 500 cells per muL or less ranged from $237 to $1691 per DALY averted compared with 2010 guidelines. In Zambia, expansion of eligibility to adults with a CD4 count threshold of 500 cells per muL ranged from improving health outcomes while reducing costs (ie, dominating the previous guidelines) to $749 per DALY averted. In both countries results were similar for expansion of eligibility to all HIV-positive adults, and when substantially expanded treatment coverage was assumed. Expansion of treatment coverage in the general population was also cost effective. In India, the cost for extending eligibility to all HIV-positive adults ranged from $131 to $241 per DALY averted, and in Vietnam extending eligibility to patients with CD4 counts of 500 cells per muL or less cost $290 per DALY averted. In concentrated epidemics, expanded access for key populations was also cost effective. INTERPRETATION: Our estimates suggest that earlier eligibility for antiretroviral therapy is very cost effective in low-income and middle-income settings, although these estimates should be revisited when more data become available. Scaling up antiretroviral therapy through earlier eligibility and expanded coverage should be considered alongside other high-priority health interventions competing for health budgets. FUNDING: Bill & Melinda Gates Foundation, WHO. |
| Databáze: | OpenAIRE |
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