title: Cost-effectiveness of alternative strategies for initiating and monitoring highly active antiretroviral therapy in the developing world.
abstract: OBJECTIVE
  Determine the cost-effectiveness of initiating and monitoring highly active antiretroviral therapy (HAART) in developing countries according to developing world versus developed world guidelines.
  
  
  METHODS
  Lifetime Markov model incorporating costs, quality of life, survival, and transmission to sexual contacts.
  
  
  METHODS
  We evaluated treating patients with HIV in South Africa according to World Health Organization (WHO) "3 by 5" guidelines (treat CD4 counts <or=200 cells/mm or patients with AIDS, and monitor CD4 cell counts every 6 months) versus modified WHO guidelines that incorporate the following key differences from developed world guidelines: treat CD4 counts <or=350 cells/mm or viral loads >100,000 copies/mL, and monitor CD4 cell counts and viral load every 3 months.
  
  
  RESULTS
  Incorporating transmission to partners (excluding indirect costs), treating patients according to developed versus developing world guidelines increased costs by US $11,867 and increased life expectancy by 3.00 quality-adjusted life-years (QALYs), for an incremental cost-effectiveness of $3956 per QALY. Including indirect costs, over the duration of the model, there are net cost savings to the economy of $39.4 billion, with increased direct medical costs of $60.5 billion offset by indirect cost savings of $99.9 billion.
  
  
  CONCLUSIONS
  Treating patients with HIV according to developed versus developing world guidelines is highly cost-effective and may result in substantial long-term savings.
authors.affiliation: Mosaic Health Care Consultants, Larkspur, CA, USA. vijayaraghavan_arthi@yahoo.com
authors.forename: Arthi
authors.initials: A
authors.lastname: Vijayaraghavan
authors.forename: Molly Bates
authors.initials: MB
authors.lastname: Efrusy
authors.forename: Peter D
authors.initials: PD
authors.lastname: Mazonson
authors.forename: Osman
authors.initials: O
authors.lastname: Ebrahim
authors.forename: Ian M
authors.initials: IM
authors.lastname: Sanne
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Santas
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics* / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D003906:Developing Countries / Q000191:economics*; D015658:HIV Infections / Q000191:economics* / Q000517:prevention & control*; D017048:Health Care Costs; D006801:Humans; D008390:Markov Chains; D018803:Models, Economic; D009010:Monte Carlo Method; D017410:Practice Guidelines as Topic; D012680:Sensitivity and Specificity; D013019:South Africa; D014481:United States; D014483:United States Dept. of Health and Human Services; D014944:World Health Organization
chemical_list: D019380:Anti-HIV Agents