| Title: |
Cost-effectiveness and budget impact of immediate antiretroviral therapy initiation for treatment of HIV infection in Côte d’Ivoire: A model-based analysis. |
| Authors: |
Ouattara, Eric N.1,2,3, MacLean, Rachel L.4, Danel, Christine1,3, Borre, Ethan D.4, Gabillard, Delphine1, Huang, Mingshu4, Moh, Raoul3, Paltiel, A. David5, Eholié, Serge P.3, Walensky, Rochelle P.4,6,7,8,9, Anglaret, Xavier1,3, Freedberg, Kenneth A.4,6,7,8,10,11 kfreedberg@mgh.harvard.edu |
| Source: |
PLoS ONE. 6/27/2019, Vol. 14 Issue 6, p1-16. 16p. |
| Subject Terms: |
*HIV infections, *LIFE expectancy, *THERAPEUTICS, *HIV infection transmission, *GROSS domestic product, *BUDGET |
| Geographic Terms: |
COTE d'Ivoire |
| Abstract: |
Introduction: The Temprano and START trials provided evidence to support early ART initiation recommendations. We projected long-term clinical and economic outcomes of immediate ART initiation in Côte d’Ivoire. Methods: We used a mathematical model to compare three potential ART initiation criteria: 1) CD4 <350/μL (ART<350/μL); 2) CD4 <500/μL (ART<500/μL); and 3) ART at presentation (Immediate ART). Outcomes from the model included life expectancy, 10-year medical resource use, incremental cost-effectiveness ratios (ICERs) in $/year of life saved (YLS), and 5-year budget impact. We simulated people with HIV (PWH) in care (mean CD4: 259/μL, SD 198/μL) and transmitted cases. Key input parameters to the analysis included first-line ART efficacy (80% suppression at 6 months) and ART cost ($90/person-year). We assessed cost-effectiveness relative to Côte d’Ivoire’s 2017 per capita annual gross domestic product ($1,600). Results: Immediate ART increased life expectancy by 0.34 years compared to ART<350/μL and 0.17 years compared to ART<500/μL. Immediate ART resulted in 4,500 fewer 10-year transmissions per 170,000 PWH compared to ART<350/μL. In cost-effectiveness analysis, Immediate ART had a 10-year ICER of $680/YLS compared to ART<350/μL, ranging from cost-saving to an ICER of $1,440/YLS as transmission rates varied. ART<500/μL was “dominated” (an inefficient use of resources), compared with Immediate ART. Immediate ART increased the 5-year HIV care budget from $801.9M to $812.6M compared to ART<350/μL. Conclusions: In Côte d’Ivoire, immediate compared to later ART initiation will increase life expectancy, decrease HIV transmission, and be cost-effective over the long-term, with modest budget impact. Immediate ART initiation is an appropriate, high-value standard of care in Côte d’Ivoire and similar settings. [ABSTRACT FROM AUTHOR] |
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