Cost-effectiveness of alternative strategies for initiating and monitoring highly active antiretroviral therapy in the developing world.
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.
Vijayaraghavan
Arthi
A
Mosaic Health Care Consultants, Larkspur, CA, USA. vijayaraghavan_arthi@yahoo.com
Efrusy
Molly Bates
MB
Mazonson
Peter D
PD
Ebrahim
Osman
O
Sanne
Ian M
IM
Santas
Christopher C
CC
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
D019380:Anti-HIV Agents