title: Cost-effectiveness of earlier initiation of antiretroviral therapy for uninsured HIV-infected adults.
abstract: OBJECTIVE
  This study was designed to examine the societal cost-effectiveness and the impact on government payers of earlier initiation of antiretroviral therapy for uninsured HIV-infected adults.
  
  
  METHODS
  A state-transition simulation model of HIV disease was used. Data were derived from the Multicenter AIDS Cohort Study, published randomized trials, and medical care cost estimates for all government payers and for Massachusetts, NewYork, and Florida.
  
  
  RESULTS
  Quality-adjusted life expectancy increased from 7.64 years with therapy initiated at 200 CD4 cells/microL to 8.21 years with therapy initiated at 500 CD4 cells/microL. Initiating therapy at 500 CD4/microL was a more efficient use of resources than initiating therapy at 200 CD4/microL and had an incremental cost-effectiveness ratio of $17,300 per quality-adjusted life-year gained, compared with no therapy. Costs to state payers in the first 5 years ranged from $5,500 to $24,900 because of differences among the states in the availability of federal funds forAIDS drug assistance programs.
  
  
  CONCLUSIONS
  Antiretroviral therapy initiated at 500 CD4 cells/microL is cost-effective from a societal: perspective compared with therapy initiated later. States should consider Medicaid waivers to expand access to early therapy.
authors.affiliation: Center for Risk Analysis, Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass, USA. brs2006A@med.cornell.edu
authors.forename: B R
authors.initials: BR
authors.lastname: Schackman
authors.forename: S J
authors.initials: SJ
authors.lastname: Goldie
authors.forename: M C
authors.initials: MC
authors.lastname: Weinstein
authors.forename: E
authors.initials: E
authors.lastname: Losina
authors.forename: H
authors.initials: H
authors.lastname: Zhang
authors.forename: K A
authors.initials: KA
authors.lastname: Freedberg
mesh_terms: D019380:Anti-HIV Agents / Q000097:blood / Q000191:economics* / Q000276:immunology / Q000627:therapeutic use*; D002017:Budgets / Q000706:statistics & numerical data; D018791:CD4 Lymphocyte Count; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D016527:Drug Costs / Q000706:statistics & numerical data*; D005260:Female; D005431:Florida; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008404:Massachusetts; D008484:Medicaid / Q000191:economics; D017057:Medically Uninsured; D017059:Models, Econometric; D009518:New York; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D013219:State Government; D013997:Time Factors
chemical_list: D019380:Anti-HIV Agents