title: Comparing costs and effectiveness of different starting points for highly active antiretroviral therapy in HIV-positive patients. Evidence from the ICONA cohort.
abstract: We evaluated the costs and effectiveness of starting highly active antiretroviral therapy (HAART) at different points during the course of HIV infection, defined on the basis of CD4 T-lymphocytes counts. The study considered 3,250 HAART-naive patients of the Italian Cohort Naive Antiretrovirals (ICONA), enrolled and followed between 1997 and 2002. In correspondence to the thresholds of 500, 350, and 200 CD4 cells/mm(3), we selected immediate and deferred groups accounting for lead-time bias. The effects of immediate vs. deferred treatment on AIDS-free survival and direct health costs were estimated stratifying on the propensity score of immediate HAART initiation. The incremental cost-effectiveness ratio (ICER) and the cost-effectiveness acceptability curve were also obtained. Although immediate HAART initiation did not affect incidence AIDS and death at high CD4 levels, starting HAART with 200-349 CD4 cells/mm(3) rather than deferring it below 200 CD4 cells/mm(3), proved to be cost-effective.
authors.affiliation: Sant'Anna School of Advanced Studies, Pisa, Italy. merito@sssup.it
authors.forename: Monica
authors.initials: M
authors.lastname: Merito
authors.forename: Patrizio
authors.initials: P
authors.lastname: Pezzotti
mesh_terms: D023241:Antiretroviral Therapy, Highly Active / Q000191:economics* / Q000379:methods*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D017850:Economics, Pharmaceutical; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D008297:Male; D017059:Models, Econometric; D016019:Survival Analysis