The cost-effectiveness of antiretroviral therapy for treating HIV disease in the Caribbean.
BACKGROUND
Antiretroviral therapy (ART) recently became available in the Organization of Eastern Caribbean States (OECS). Survival benefits and budgetary implications associated with universal access to ART have not been examined in the Caribbean.


METHODS
Using a state-transition simulation model of HIV with regional data, we projected survival, cost, and cost-effectiveness of treating an HIV-infected cohort. We examined 1 or 2 ART regimens and cotrimoxazole. In sensitivity analysis, we varied HIV natural history and ART efficacy, cost, and switching criteria.


RESULTS
Without treatment, mean survival was 2.30 years (mean baseline CD4 count = 288 cells/microL). One ART regimen with cotrimoxazole when the CD4 count was <350 cells/microL provided an additional 5.86 years of survival benefit compared with no treatment; the incremental cost-effectiveness ratio was $690 per year of life saved (YLS). A second regimen added 1.04 years of survival benefit; the incremental cost-effectiveness ratio was $10,960 per YLS compared with 1 regimen. Results were highly dependent on second-line ART costs. Per-person lifetime costs decreased from $17,020 to $9290 if second-line ART costs decreased to those available internationally, yielding approximately $8 million total savings.


CONCLUSIONS
In the OECS, ART is cost-effective by international standards. Reducing second-line ART costs increases cost-effectiveness and affordability. Current funding supports implementing universal access regionally over the next year, but additional funding is required to sustain lifetime care for currently infected persons.
Wolf
Lindsey L
LL
Division of General Medicine and the Partners AIDS Research Center, Massachusetts General Hospital, Boston, MA 02114, USA. llwolf@partners.org
Ricketts
Paul
P
Freedberg
Kenneth A
KA
Williams-Roberts
Hazel
H
Hirschhorn
Lisa R
LR
Allen-Ferdinand
Kathleen
K
Rodriguez
William R
WR
Divi
Nomita
N
Wong
Michael T
MT
Losina
Elena
E
D000328:Adult; D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D017691:Caribbean Region; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics* / Q000276:immunology / Q000401:mortality; D006801:Humans; D008297:Male; D016019:Survival Analysis
D019380:Anti-HIV Agents