title: Cost-effectiveness of HIV treatment as prevention in serodiscordant couples.
abstract: BACKGROUND
  The cost-effectiveness of early antiretroviral therapy (ART) in persons infected with human immunodeficiency virus (HIV) in serodiscordant couples is not known. Using a computer simulation of the progression of HIV infection and data from the HIV Prevention Trials Network 052 study, we projected the cost-effectiveness of early ART for such persons.
  
  
  METHODS
  For HIV-infected partners in serodiscordant couples in South Africa and India, we compared the early initiation of ART with delayed ART. Five-year and lifetime outcomes included cumulative HIV transmissions, life-years, costs, and cost-effectiveness. We classified early ART as very cost-effective if its incremental cost-effectiveness ratio was less than the annual per capita gross domestic product (GDP; $8,100 in South Africa and $1,500 in India), as cost-effective if the ratio was less than three times the GDP, and as cost-saving if it resulted in a decrease in total costs and an increase in life-years, as compared with delayed ART.
  
  
  RESULTS
  In South Africa, early ART prevented opportunistic diseases and was cost-saving over a 5-year period; over a lifetime, it was very cost-effective ($590 per life-year saved). In India, early ART was cost-effective ($1,800 per life-year saved) over a 5-year period and very cost-effective ($530 per life-year saved) over a lifetime. In both countries, early ART prevented HIV transmission over short periods, but longer survival attenuated this effect; the main driver of life-years saved was a clinical benefit for treated patients. Early ART remained very cost-effective over a lifetime under most modeled assumptions in the two countries.
  
  
  CONCLUSIONS
  In South Africa, early ART was cost-saving over a 5-year period. In both South Africa and India, early ART was projected to be very cost-effective over a lifetime. With individual, public health, and economic benefits, there is a compelling case for early ART for serodiscordant couples in resource-limited settings. (Funded by the National Institute of Allergy and Infectious Diseases and others.).
authors.affiliation: The authors' affiliations are listed in the Appendix.
authors.forename: Rochelle P
authors.initials: RP
authors.lastname: Walensky
authors.forename: Eric L
authors.initials: EL
authors.lastname: Ross
authors.forename: Nagalingeswaran
authors.initials: N
authors.lastname: Kumarasamy
authors.forename: Robin
authors.initials: R
authors.lastname: Wood
authors.forename: Farzad
authors.initials: F
authors.lastname: Noubary
authors.forename: A David
authors.initials: AD
authors.lastname: Paltiel
authors.forename: Yoriko M
authors.initials: YM
authors.lastname: Nakamura
authors.forename: Sheela V
authors.initials: SV
authors.lastname: Godbole
authors.forename: Ravindre
authors.initials: R
authors.lastname: Panchia
authors.forename: Ian
authors.initials: I
authors.lastname: Sanne
authors.forename: Milton C
authors.initials: MC
authors.lastname: Weinstein
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.forename: Ying Q
authors.initials: YQ
authors.lastname: Chen
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.forename: Marybeth
authors.initials: M
authors.lastname: McCauley
authors.forename: Theresa
authors.initials: T
authors.lastname: Gamble
authors.forename: George R
authors.initials: GR
authors.lastname: Seage
authors.forename: Myron S
authors.initials: MS
authors.lastname: Cohen
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D018562:Disease Transmission, Infectious / Q000517:prevention & control* / Q000706:statistics & numerical data; D004334:Drug Administration Schedule; D005260:Female; D059066:Gross Domestic Product; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000635:transmission; D017048:Health Care Costs; D006801:Humans; D007194:India; D008297:Male; D013019:South Africa
chemical_list: D044966:Anti-Retroviral Agents