title: Cost-effectiveness of early treatment with first-line NNRTI-based HAART regimens in the UK, 1996-2006.
abstract: OBJECTIVE
  Calculate time to first-line treatment failure, annual cost and cost-effectiveness of NNRTI versus PIboosted first-line HAART regimens in the UK, 1996-2006.
  
  
  BACKGROUND
  Population costs for HIV services are increasing in the UK and interventions need to be effective and efficient to reduce or stabilize costs. 2NRTIs + NNRTI regimens are cost-effective regimens for first-line HAART, but these regimens have not been compared with first-line PI(boosted) regimens.
  
  
  METHODS
  Times to first-line treatment failure and annual costs were calculated for first-line HAART regimens by CD4 count when starting HAART (2006 UK prices). Cost-effectiveness of 2NRTIs+NNRTI versus 2NRTIs+PI(boosted) regimens was calculated for four CD4 strata.
  
  
  RESULTS
  55% of 5,541 people living with HIV (PLHIV) started HAART with CD4 count ≤ 200 cells/mm3, many of whom were Black Africans. Annual treatment cost decreased as CD4 count increased; most marked differences were observed between starting HAART with CD4 ≤ 200 cells/mm3 compared with CD4 count >200 cells/mm3. 2NRTI+PI(boosted) and 2NRTI+NNRTI regimens were the most effective regimens across the four CD4 strata; 2NRTI + NNRTI was cost-saving or cost-effective compared with 2NRTI + PI(boosted) regimens.
  
  
  CONCLUSIONS
  To ensure more effective and efficient provision of HIV services, 2NRTI+NNRTI should be started as first-line HAART regimen at CD4 counts ≤ 350 cell/mm3, unless specific contra-indications exist. This will increase the number of PLHIV receiving HAART and will initially increase population costs of providing HIV services. However, starting PLHIV earlier on cost-effective regimens will maintain them in better health and use fewer health or social services, thereby generating fewer treatment and care costs, enabling them to remain socially and economically active members of society. This does raise a number of ethical issues, which will have to be acknowledged and addressed, especially in countries with limited resources.
authors.affiliation: NPMS-HHC Coordinating and Analytic Centre, London, United Kingdom. becke@unaids.org
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Beck
authors.forename: Sundhiya
authors.initials: S
authors.lastname: Mandalia
authors.forename: Gary
authors.initials: G
authors.lastname: Lo
authors.forename: Peter
authors.initials: P
authors.lastname: Sharott
authors.forename: Mike
authors.initials: M
authors.lastname: Youle
authors.forename: Jane
authors.initials: J
authors.lastname: Anderson
authors.forename: Guy
authors.initials: G
authors.lastname: Baily
authors.forename: Ray
authors.initials: R
authors.lastname: Brettle
authors.forename: Martin
authors.initials: M
authors.lastname: Fisher
authors.forename: Mark
authors.initials: M
authors.lastname: Gompels
authors.forename: George
authors.initials: G
authors.lastname: Kinghorn
authors.forename: Margaret
authors.initials: M
authors.lastname: Johnson
authors.forename: Brendan
authors.initials: B
authors.lastname: McCarron
authors.forename: Anton
authors.initials: A
authors.lastname: Pozniak
authors.forename: Alan
authors.initials: A
authors.lastname: Tang
authors.forename: John
authors.initials: J
authors.lastname: Walsh
authors.forename: David
authors.initials: D
authors.lastname: White
authors.forename: Ian
authors.initials: I
authors.lastname: Williams
authors.forename: Brian
authors.initials: B
authors.lastname: Gazzard
mesh_terms: D000328:Adult; D000465:Algorithms; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods* / Q000706:statistics & numerical data; D018791:CD4 Lymphocyte Count; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D016019:Survival Analysis; D013997:Time Factors; D006113:United Kingdom
chemical_list: D018894:Reverse Transcriptase Inhibitors