Journal Article

Cost-Effectiveness of Early Versus Standard Antiretroviral Therapy in HIV-Infected Adults in Haiti

Fitzgerald, Daniel W., Riviere, Cynthia, Jean Juste, Marc Antoine, Ambroise, Alex, Bang, Heejung, Edwards, Alison, McGreevy, Jolion, Koenig, Serena P., Marcelin, Serge, Hippolyte, Jessica, Schackman, Bruce R., Pape, Jean W., Secours, Rode, Johnson, Warren D., Severe, Patrice

2011

Overview

In a randomized clinical trial of early versus standard antiretroviral therapy (ART) in HIV-infected adults with a CD4 cell count between 200 and 350 cells/mm³ in Haiti, early ART decreased mortality by 75%. We assessed the cost-effectiveness of early versus standard ART in this trial. Trial data included use of ART and other medications, laboratory tests, outpatient visits, radiographic studies, procedures, and hospital services. Medication, laboratory, radiograph, labor, and overhead costs were from the study clinic, and hospital and procedure costs were from local providers. We evaluated cost per year of life saved (YLS), including patient and caregiver costs, with a median of 21 months and maximum of 36 months of follow-up, and with costs and life expectancy discounted at 3% per annum. Between 2005 and 2008, 816 participants were enrolled and followed for a median of 21 months. Mean total costs per patient during the trial were US$1,381 for early ART and US$1,033 for standard ART. After excluding research-related laboratory tests without clinical benefit, costs were US$1,158 (early ART) and US$979 (standard ART). Early ART patients had higher mean costs for ART (US$398 versus US$81) but lower costs for non-ART medications, CD4 cell counts, clinically indicated tests, and radiographs (US$275 versus US$384). The cost-effectiveness ratio after a maximum of 3 years for early versus standard ART was US$3,975/YLS (95% CI US$2,129/YLS-US$9,979/YLS) including research-related tests, and US$2,050/YLS excluding research-related tests (95% CI US$722/YLS-US$5,537/YLS). Initiating ART in HIV-infected adults with a CD4 cell count between 200 and 350 cells/mm³ in Haiti, consistent with World Health Organization advice, was cost-effective (US$/YLS <3 times gross domestic product per capita) after a maximum of 3 years, after excluding research-related laboratory tests. ClinicalTrials.gov NCT00120510.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Acquired immune deficiency syndrome / Adult / AIDS / Anti-Retroviral Agents - administration & dosage / Anti-Retroviral Agents - adverse effects / Anti-Retroviral Agents - economics / Antiretroviral drugs / Antiviral agents / CD4 Lymphocyte Count / Clinical trials / Cost-Benefit Analysis / Delivery of Health Care - economics / Delivery of Health Care - standards / Development and progression / Drug Administration Schedule / Drug therapy / Female / Guidelines as Topic / Haiti / Health aspects / Health Care Costs / HIV / HIV infection / HIV Infections - drug therapy / HIV Infections - economics / Human immunodeficiency virus / Humans / Life Expectancy / Male / Medicine / Political aspects / Social and Behavioral Sciences / Standard of Care - economics