Antiretroviral therapy and HIV prevention in India: modeling costs and consequences of policy options.
OBJECTIVE
The objective of this study is to assess the costs, cost-effectiveness, and HIV epidemic impact of 3 antiretroviral therapy (ART) policy options.


METHODS
We constructed an epidemiologic model to predict the course of the HIV epidemic in the absence of expanded ART availability. Based on background studies of the willingness to pay for ART among patients with AIDS, of the costs to the government of the alternative treatment interventions, and of ART's likely effects on HIV transmission, we simulated the consequences of 3 possible alternative government ART policies.


RESULTS
A program to reduce the negative consequences of the currently unstructured private-sector provision of ART is the most cost-effective of the 3 options at a 10% discount rate and least cost-effective at a 3% rate. The costs and cost-effectiveness of all options are highly sensitive to the effect of ART on condom use.


CONCLUSIONS
The design of ART policy should capitalize on the potential of ART to decrease HIV transmission through institutional arrangements that reward effective prevention programs, thereby raising the likelihood that treatment has beneficial rather than negative external effects.
Over
Mead
M
World Bank, Washington, DC 20433, USA. meadover@worldbank.org
Marseille
Elliot
E
Sudhakar
Kurapati
K
Gold
Julian
J
Gupta
Indrani
I
Indrayan
Abhaya
A
Hira
Subhash
S
Nagelkerke
Nico
N
Rao
Arni S R Srinivasa
AS
Heywood
Peter
P
D000998:Antiviral Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D006078:Government Programs / Q000191:economics*; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007194:India / Q000453:epidemiology; D008962:Models, Theoretical; D011640:Public Policy
D000998:Antiviral Agents