title: Cost-effectiveness of highly active antiretroviral therapy for HIV infection in Taiwan.
abstract: OBJECTIVE
  Since the late 1980s, the Taiwanese government has provided all HIV-infected citizens with free access to antiretroviral therapy. Recently, there is controversy as to whether or not free access to expensive highly active antiretroviral therapy (HAART) should be continued for HIV-infected patients. This study aimed to evaluate the cost-effectiveness of HAART therapy.
  
  
  METHODS
  HAART-associated improvement in survival was obtained by analyzing the follow-up data of all HIV-positive patients identified during April 1984 to March 1997 (pre-HAART era) and May 1997 to April 2003 (HAART era) in Taiwan. Data on quality of life in HIV-positive patients was obtained from a cross-sectional survey of 224 patients using standard gamble method and World Health Organization Quality of Life-BREF instrument. Information regarding the cost of HAART was obtained from the National Health Insurance (NHI).
  
  
  RESULTS
  In 2000, the average annual NHI expenditure on HAART per HIV-positive patient receiving HAART was NT$210,018 (US$6177, at an exchange rate of 34.0 NT$/US$). In the AIDS group, the cost was NT$176,441 (US$5189) per life year gained and NT$241,700 (US$7109) per quality-adjusted life year gained. For non-AIDS patients, the corresponding costs were NT$226,156 (US$6652) and NT$332,582 (US$9782), respectively. These estimates have not yet included the additional cost savings from HAART-associated reduction in hospitalization and use of antimicrobial agents for opportunistic infections, and the additional life years gained from the reduction in HIV transmission under the universal availability of HAART.
  
  
  CONCLUSIONS
  HAART for HIV infection is cost-effective, especially when the societal and epidemiologic factors are considered. We recommend that the policy of providing free HAART to all HIV-infected citizens be continued.
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Chi-Tai
authors: CT
authors: Fang
authors: Yu-Yin
authors: YY
authors: Chang
authors: Hsu-Mei
authors: HM
authors: Hsu
authors: Shiing-Jer
authors: SJ
authors: Twu
authors: Kow-Tong
authors: KT
authors: Chen
authors: Mao-Yuan
authors: MY
authors: Chen
authors: Loreen Y L
authors: LY
authors: Huang
authors: Jing-Shiang
authors: JS
authors: Hwang
authors: Jung-Der
authors: JD
authors: Wang
mesh_terms: D023241:Antiretroviral Therapy, Highly Active / Q000191:economics*; D003362:Cost-Benefit Analysis; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D013624:Taiwan