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Cost-effectiveness of alternative strategies for initiating and monitoring highly active antiretroviral therapy in the developing world.

PMID: 17621241 (view PubMed database entry)
DOI: 10.1097/qai.0b013e3181342564 (read at publisher's website )

Arthi Vijayaraghavan, Molly Bates Efrusy, Peter D Mazonson, Osman Ebrahim, Ian M Sanne, Christopher C Santas,

<h4>Objective</h4>Determine the cost-effectiveness of initiating and monitoring highly active antiretroviral therapy (HAART) in developing countries according to developing world versus developed world guidelines.<h4>Design</h4>Lifetime Markov model incorporating costs, quality of life, survival, and transmission to sexual contacts.<h4>Methods</h4>We evaluated treating patients with HIV in South Africa according to World Health Organization (WHO) "3 by 5" guidelines (treat CD4 counts <or=200 cells/mm or patients with AIDS, and monitor CD4 cell counts every 6 months) versus modified WHO guidelines that incorporate the following key differences from developed world guidelines: treat CD4 counts <or=350 cells/mm or viral loads >100,000 copies/mL, and monitor CD4 cell counts and viral load every 3 months.<h4>Results</h4>Incorporating transmission to partners (excluding indirect costs), treating patients according to developed versus developing world guidelines increased costs by US $11,867 and increased life expectancy by 3.00 quality-adjusted life-years (QALYs), for an incremental cost-effectiveness of $3956 per QALY. Including indirect costs, over the duration of the model, there are net cost savings to the economy of $39.4 billion, with increased direct medical costs of $60.5 billion offset by indirect cost savings of $99.9 billion.<h4>Conclusions</h4>Treating patients with HIV according to developed versus developing world guidelines is highly cost-effective and may result in substantial long-term savings.

J Acquir Immune Defic Syndr (Journal of acquired immune deficiency syndromes (1999))
[2007, 46(1):91-100]

Cited: 36 times

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