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- Publisher Website: 10.1097/QAD.0b013e328137709e
- Scopus: eid_2-s2.0-34249992820
- PMID: 17545710
- WOS: WOS:000247556800013
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Article: The cost effectiveness of antiretroviral treatment strategies in resource-limited settings
Title | The cost effectiveness of antiretroviral treatment strategies in resource-limited settings |
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Authors | |
Keywords | AIDS Antiretroviral treatment CD4 lymphocytes Cost effectiveness Developing countries HIV Laboratory testing Resource-limited settings Viral load |
Issue Date | 2007 |
Citation | AIDS, 2007, v. 21, n. 10, p. 1333-1340 How to Cite? |
Abstract | BACKGROUND: Optimal resource allocation for antiretroviral treatment (ART) in developing countries requires assessment of different strategies for drug treatment and laboratory monitoring. OBJECTIVES: To compare costs and outcomes for 10 000 simulated HIV-infected patients followed every 6 months for 10 years in a limited-resource setting. METHOD: Five nested strategies, with and without the availability of a second-line treatment regimen, were simulated: (a) no ART (NO ART); (b) with ART but without any laboratory markers of HIV other than positive serology (ART ONLY); (c) ART plus total lymphocyte count (TLC); (d) ART plus CD4 cell counts (CD4); and (e) ART plus CD4 cell count plus viral load measurement (VL). Baseline prices of CD4 cell count and viral load measurements were $5.00 and $25.00 per test, respectively. RESULTS: With no second-line treatment available, treating 10 000 patients with ART ONLY compared with NO ART would cost $14.49 million [95% confidence interval (CI), 14.45-14.52] and would generate an additional 23 060 quality-adjusted life years (QALYS) (95% CI, 22 770-23 360) for a median incremental cost effectiveness ratio (ICER) of $628/QALY. Median ICER values per QALY for CD4 and VL strategies are $238 and $16 139, respectively, when second-line treatment is unavailable. With second-line ART available, the corresponding median ICER values are $8636, and $14 670. CONCLUSIONS: In the absence of second-line ART, the CD4 strategy is a more cost-effective laboratory testing strategy for managing HIV infection than either TLC or VL. Availability of second-line ART plus CD4 cell count and/or viral load measurement would save additional lives, but at high incremental cost. © 2007 Lippincott Williams & Wilkins, Inc. |
Persistent Identifier | http://hdl.handle.net/10722/326724 |
ISSN | 2023 Impact Factor: 3.4 2023 SCImago Journal Rankings: 1.401 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Bishai, David | - |
dc.contributor.author | Colchero, Arantxa | - |
dc.contributor.author | Durack, David T. | - |
dc.date.accessioned | 2023-03-31T05:26:04Z | - |
dc.date.available | 2023-03-31T05:26:04Z | - |
dc.date.issued | 2007 | - |
dc.identifier.citation | AIDS, 2007, v. 21, n. 10, p. 1333-1340 | - |
dc.identifier.issn | 0269-9370 | - |
dc.identifier.uri | http://hdl.handle.net/10722/326724 | - |
dc.description.abstract | BACKGROUND: Optimal resource allocation for antiretroviral treatment (ART) in developing countries requires assessment of different strategies for drug treatment and laboratory monitoring. OBJECTIVES: To compare costs and outcomes for 10 000 simulated HIV-infected patients followed every 6 months for 10 years in a limited-resource setting. METHOD: Five nested strategies, with and without the availability of a second-line treatment regimen, were simulated: (a) no ART (NO ART); (b) with ART but without any laboratory markers of HIV other than positive serology (ART ONLY); (c) ART plus total lymphocyte count (TLC); (d) ART plus CD4 cell counts (CD4); and (e) ART plus CD4 cell count plus viral load measurement (VL). Baseline prices of CD4 cell count and viral load measurements were $5.00 and $25.00 per test, respectively. RESULTS: With no second-line treatment available, treating 10 000 patients with ART ONLY compared with NO ART would cost $14.49 million [95% confidence interval (CI), 14.45-14.52] and would generate an additional 23 060 quality-adjusted life years (QALYS) (95% CI, 22 770-23 360) for a median incremental cost effectiveness ratio (ICER) of $628/QALY. Median ICER values per QALY for CD4 and VL strategies are $238 and $16 139, respectively, when second-line treatment is unavailable. With second-line ART available, the corresponding median ICER values are $8636, and $14 670. CONCLUSIONS: In the absence of second-line ART, the CD4 strategy is a more cost-effective laboratory testing strategy for managing HIV infection than either TLC or VL. Availability of second-line ART plus CD4 cell count and/or viral load measurement would save additional lives, but at high incremental cost. © 2007 Lippincott Williams & Wilkins, Inc. | - |
dc.language | eng | - |
dc.relation.ispartof | AIDS | - |
dc.subject | AIDS | - |
dc.subject | Antiretroviral treatment | - |
dc.subject | CD4 lymphocytes | - |
dc.subject | Cost effectiveness | - |
dc.subject | Developing countries | - |
dc.subject | HIV | - |
dc.subject | Laboratory testing | - |
dc.subject | Resource-limited settings | - |
dc.subject | Viral load | - |
dc.title | The cost effectiveness of antiretroviral treatment strategies in resource-limited settings | - |
dc.type | Article | - |
dc.description.nature | link_to_subscribed_fulltext | - |
dc.identifier.doi | 10.1097/QAD.0b013e328137709e | - |
dc.identifier.pmid | 17545710 | - |
dc.identifier.scopus | eid_2-s2.0-34249992820 | - |
dc.identifier.volume | 21 | - |
dc.identifier.issue | 10 | - |
dc.identifier.spage | 1333 | - |
dc.identifier.epage | 1340 | - |
dc.identifier.isi | WOS:000247556800013 | - |