Cost-effectiveness analysis of antiretroviral drug treatment and HIV-1 vaccination in Thailand.
The prevalence of adult HIV/AIDS in Thailand is declining due to intense prevention strategies, but it still continues to be a critical health problem with a prevalence of 1.5%. Several HIV vaccine candidates for the prevention of HIV infection or progress to AIDS were examined in clinical trials. We evaluated the cost-effectiveness of a vaccination regimen (rBCG prime-rDIs boost) currently in its pre-clinical phase. The cost-effectiveness of three interventions (vaccination, highly active antiretroviral treatment [HAART], and the combination of the two) through an existing vaccination program was assessed in a Markov model. The disability-adjusted life year (DALY) was the main effectiveness measure. In the base case the efficacy of the vaccine for preventing HIV infection was assumed to be 30%. The cost of the vaccine was estimated on the basis of its predicted production capacities in Thailand. The incremental cost-effectiveness ratios of vaccination, HAART, and the combination were about dollar US 75, dollar US 610, and dollar US 267 per DALY averted compared with the do-nothing strategy in the base case. The HAART-only strategy seemed to be less cost-effective than the other options under the current assumptions. Sensitivity analyses indicated that the new HIV infection rate and the vaccine efficacy could affect the results.
Ono
Shunsuke
S
Graduate School of Natural Science and Technology, Kanazawa University, Kanazawa 920-1191, Japan. shunono@pep.ne.jp
Kurotaki
Takako
T
Nakasone
Tadashi
T
Honda
Mitsuo
M
Boon-Long
Jotika
J
Sawanpanyalert
Pathom
P
Kimura
Kazuko
K
D016915:AIDS Vaccines / Q000191:economics* / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000191:economics / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics* / Q000379:methods; D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000191:economics / Q000276:immunology / Q000628:therapy*; D006801:Humans; D008297:Male; D008390:Markov Chains; D013785:Thailand
D016915:AIDS Vaccines; D044966:Anti-Retroviral Agents