Economic evaluation of ART in resource-limited countries.
OBJECTIVE
In the face of increasing economic constraints, it is critically important to evaluate how best to utilize available resources. In this article, we review the growing number of cost-effectiveness analyses of HIV treatment with antiretroviral therapy (ART) in resource-limited settings. We focus on studies that evaluate when to start therapy, what therapy to start with and what to switch to based on what criteria.


RESULTS
Recent findings show that earlier ART initiation based on CD4 cell count criteria (CD4 cell counts <350 cells/microl) can be cost effective in most resource-limited settings. They also suggest that initiating ART with tenofovir as a component of the first-line regimen is an efficient use of resources compared with initiating ART with stavudine. Finally, they show that HIV RNA monitoring combined with CD4 monitoring is more effective than CD4 monitoring alone, although this strategy was not yet found to be cost effective in all studies. Nearly all studies demonstrate, however, that the cost-effectiveness ratio of HIV RNA monitoring will become more attractive as the cost of HIV RNA tests and second-line ART regimens decrease.


CONCLUSIONS
Substantial research shows that ART for HIV disease in resource-limited settings is cost effective. Improved initial regimens and increased laboratory monitoring may provide both clinical benefit and good value for money. Further price reductions of laboratory tests and recent antiretroviral drugs are needed to guarantee the cost-effectiveness of these required improvements.
Loubiere
Sandrine
S
INSERM/IRD/University of the Mediterranean - UMR 'Economics & Social Sciences, Health Systems & Societies' and Southeastern Health Regional Observatory, Marseille, France. sandrine.loubiere@inserm.fr <sandrine.loubiere@inserm.fr>
Meiners
Constance
C
Sloan
Caroline
C
Freedberg
Kenneth A
KA
Yazdanpanah
Yazdan
Y
D000225:Adenine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics*; D018791:CD4 Lymphocyte Count; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D016903:Drug Monitoring / Q000379:methods; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics*; D017048:Health Care Costs; D006801:Humans; D063065:Organophosphonates / Q000191:economics / Q000627:therapeutic use; D012367:RNA, Viral / Q000097:blood; D018119:Stavudine / Q000191:economics / Q000627:therapeutic use; D000068698:Tenofovir; D019562:Viral Load / Q000379:methods
D019380:Anti-HIV Agents; D063065:Organophosphonates; D012367:RNA, Viral; D000068698:Tenofovir; D018119:Stavudine; D000225:Adenine