Cost-Effectiveness of Early Infant HIV Diagnosis of HIV-Exposed Infants and Immediate Antiretroviral Therapy in HIV-Infected Children under 24 Months in Thailand
| Autor: | Collins, Intira Jeannie, Cairns, John, Ngo-Giang-Huong, Nicole, Sirirungsi, Wasna, Leechanachai, Pranee, Le Coeur, Sophie, Samleerat, Tanawan, Kamonpakorn, Nareerat, Mekmullica, Jutarat, Jourdain, Gonzague, Lallemant, Marc, Programme for HIV Prevention and Treatment Study Team |
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| Přispěvatelé: | Institut national d'études démographiques (INED), Épidémiologie clinique, santé mère-enfant et VIH en Asie du Sud-Est (IRD_PHPT), Harvard University [Cambridge]-Chiang Mai University (CMU), Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5), Harvard University [Cambridge]-Chiang Mai university (Thaïlande), Harvard University-Chiang Mai University (CMU) |
| Jazyk: | angličtina |
| Rok vydání: | 2014 |
| Předmět: |
Male
Pediatrics Non-Clinical Medicine Cost effectiveness Economics Economic Models Cost-Benefit Analysis lcsh:Medicine HIV Infections Social and Behavioral Sciences Cost Effectiveness 0302 clinical medicine 030212 general & internal medicine lcsh:Science ComputingMilieux_MISCELLANEOUS health care economics and organizations education.field_of_study Multidisciplinary infants cost-effectiveness analysis HIV diagnosis and management Cost-effectiveness analysis [SHS.ECO]Humanities and Social Sciences/Economics and Finance Thailand 3. Good health AIDS Cohort SURVIVAL Medicine Infectious diseases Female Public Health Research Article medicine.medical_specialty Anti-HIV Agents Population antiretroviral therapy Viral diseases DIAGNOSIS JEL: I - Health Education and Welfare/I.I1 - Health/I.I1.I18 - Government Policy • Regulation • Public Health 03 medical and health sciences Health Economics Life Expectancy children Cost Models 030225 pediatrics Survivorship curve medicine Humans education business.industry Public health lcsh:R Infant Newborn HIV Infant HIV diagnostic Models Theoretical HIV infection Life expectancy Observational study lcsh:Q [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie business Infectious Disease Modeling COSTS |
| Zdroj: | PLoS ONE PLoS ONE, Public Library of Science, 2014, 14 (9), pp.e91004. ⟨10.1371/journal.pone.0091004⟩ PLoS ONE, Vol 9, Iss 3, p e91004 (2014) PLoS ONE, 2014, 14 (9), pp.e91004. ⟨10.1371/journal.pone.0091004⟩ |
| ISSN: | 1932-6203 |
| Popis: | BACKGROUND: HIV-infected infants have high risk of death in the first two years of life if untreated. WHO guidelines recommend early infant HIV diagnosis (EID) of all HIV-exposed infants and immediate antiretroviral therapy (ART) in HIV-infected children under 24-months. We assessed the cost-effectiveness of this strategy in HIV-exposed non-breastfed children in Thailand. METHODS: A decision analytic model of HIV diagnosis and disease progression compared: EID using DNA PCR with immediate ART (Early-Early); or EID with deferred ART based on immune/clinical criteria (Early-Late); vs. clinical/serology based diagnosis and deferred ART (Reference). The model was populated with survival and cost data from a Thai observational cohort and the literature. Incremental cost-effectiveness ratio per life-year gained (LYG) was compared against the Reference strategy. Costs and outcomes were discounted at 3%. RESULTS: Mean discounted life expectancy of HIV-infected children increased from 13.3 years in the Reference strategy to 14.3 in the Early-Late and 17.8 years in Early-Early strategies. The mean discounted lifetime cost was $17,335, $22,583 and $29,108, respectively. The cost-effectiveness ratio of Early-Late and Early-Early strategies was $5,149 and $2,615 per LYG, respectively as compared to the Reference strategy. The Early-Early strategy was most cost-effective at approximately half the domestic product per capita per LYG ($4,420 in Thailand 2011). The results were robust in deterministic and probabilistic sensitivity analyses including varying perinatal transmission rates. CONCLUSION: In Thailand, EID and immediate ART would lead to major survival benefits and is cost- effective. These findings strongly support the adoption of WHO recommendations as routine care. |
| Databáze: | OpenAIRE |
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