title: The cost-effectiveness of early access to HIV services and starting cART in the UK 1996-2008.
abstract: OBJECTIVE
  To calculate use, cost and cost-effectiveness of people living with HIV (PLHIV) starting routine treatment and care before starting combination antiretroviral therapy (cART) and PLHIV starting first-line 2NRTIs+NNRTI or 2NRTIs+PI(boosted), comparing PLHIV with CD4≤200 cells/mm3 and CD4>200 cells/mm3. Few studies have calculated the use, cost and cost-effectiveness of routine treatment and care before starting cART and starting cART above and below CD4 200 cells/mm3.
  
  
  METHODS
  Use, costs and cost-effectiveness were calculated for PLHIV in routine pre-cART and starting first-line cART, comparing CD4≤200 cells/mm3 with CD4>200 cells/mm3 (2008 UK prices).
  
  
  RESULTS
  cART naïve patients CD4≤200 cells/mm3 had an annual cost of £6,407 (95%CI £6,382 to £6,425) PPY compared with £2,758 (95%CI £2,752 to £2,761) PPY for those with CD4>200 cells/mm3; cost per life year gained of pre-cART treatment and care for those with CD4>200 cells/mm3 was £1,776 (cost-saving to £2,752). Annual cost for starting 2NRTIs+NNRTI or 2NRTIs+PI(boosted) with CD4≤200 cells/mm3 was £12,812 (95%CI £12,685-£12,937) compared with £10,478 (95%CI £10,376-£10,581) for PLHIV with CD4>200 cells/mm3. Cost per additional life-year gained on first-line therapy for those with CD4>200 cells/mm3 was £4639 (£3,967 to £2,960).
  
  
  CONCLUSIONS
  PLHIV starting to use HIV services before CD4≤200 cells/mm3 is cost-effective and enables them to be monitored so they start cART with a CD4>200 cells/mm3, which results in better outcomes and is cost-effective. However, 25% of PLHIV accessing services continue to present with CD4≤200 cells/mm3. This highlights the need to investigate the cost-effectiveness of testing and early treatment programs for key populations in the UK.
authors.affiliation: NPMS-HHC CIC, 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: Roshni
authors.initials: R
authors.lastname: Sangha
authors.forename: Peter
authors.initials: P
authors.lastname: Sharott
authors.forename: Mike
authors.initials: M
authors.lastname: Youle
authors.forename: Guy
authors.initials: G
authors.lastname: Baily
authors.forename: Ray
authors.initials: R
authors.lastname: Brettle
authors.forename: Mark
authors.initials: M
authors.lastname: Gompels
authors.forename: Margaret
authors.initials: M
authors.lastname: Johnson
authors.forename: Brendan
authors.initials: B
authors.lastname: McCarron
authors.forename: Ed
authors.initials: E
authors.lastname: Ong
authors.forename: Anton
authors.initials: A
authors.lastname: Pozniak
authors.forename: Achim
authors.initials: A
authors.lastname: Schwenk
authors.forename: Stephen
authors.initials: S
authors.lastname: Taylor
authors.forename: John
authors.initials: J
authors.lastname: Walsh
authors.forename: Ed
authors.initials: E
authors.lastname: Wilkins
authors.forename: Ian
authors.initials: I
authors.lastname: Williams
authors.forename: Brian
authors.initials: B
authors.lastname: Gazzard
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics*; D003362:Cost-Benefit Analysis; D003710:Demography; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D006113:United Kingdom