The cost effectiveness of combination antiretroviral therapy for HIV disease.
BACKGROUND
Combination antiretroviral therapy with a combination of three or more drugs has become the standard of care for patients with human immunodeficiency virus (HIV) infection in the United States. We estimated the clinical benefits and cost effectiveness of three-drug antiretroviral regimens.


METHODS
We developed a mathematical simulation model of HIV disease, using the CD4 cell count and HIV RNA level as predictors of the progression of disease. Outcome measures included life expectancy, life expectancy adjusted for the quality of life, lifetime direct medical costs, and cost effectiveness in dollars per quality-adjusted year of life gained. Clinical data were derived from major clinical trials, including the AIDS Clinical Trials Group 320 Study. Data on costs were based on the national AIDS Cost and Services Utilization Survey, with drug costs obtained from the Red Book.


RESULTS
For patients similar to those in the AIDS Clinical Trials Group 320 Study (mean CD4 cell count, 87 per cubic millimeter), life expectancy adjusted for the quality of life increased from 1.53 to 2.91 years, and per-person lifetime costs increased from $45,460 to $77,300 with three-drug therapy as compared with no therapy. The incremental cost per quality-adjusted year of life gained, as compared with no therapy, was $23,000. On the basis of additional data from other major studies, the cost-effectiveness ratio for three-drug therapy ranged from $13,000 to $23,000 per quality-adjusted year of life gained. The initial CD4 cell count and drug costs were the most important determinants of costs, clinical benefits, and cost effectiveness.


CONCLUSIONS
Treatment of HIV infection with a combination of three antiretroviral drugs is a cost-effective use of resources.
Division of General Internal Medicine and the Partners AIDS Research Center, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA. kfreedberg@partners.org
K A
KA
Freedberg
E
E
Losina
M C
MC
Weinstein
A D
AD
Paltiel
C J
CJ
Cohen
G R
GR
Seage
D E
DE
Craven
H
H
Zhang
A D
AD
Kimmel
S J
SJ
Goldie
D017088:AIDS-Related Opportunistic Infections / Q000191:economics / Q000517:prevention & control; D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D004180:Direct Service Costs / Q000706:statistics & numerical data; D018450:Disease Progression; D016527:Drug Costs / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008017:Life Expectancy; D008954:Models, Biological; D019057:Quality-Adjusted Life Years; D012367:RNA, Viral / Q000097:blood; D014481:United States; D026712:Value of Life
D019380:Anti-HIV Agents; D012367:RNA, Viral