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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Cost-effectiveness of HIV treatment as prevention in serodiscordant couples
New England Journal of Medicine, Volume 369, No. 18, Year 2013
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Description
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. Copyright © 2013 Massachusetts Medical Society.
Authors & Co-Authors
Walensky, Rochelle P.
United States, Boston
Massachusetts General Hospital
United States, Boston
Brigham and Women's Hospital
United States, Boston
Harvard Medical School
Ross, Eric L.
United States, Boston
Massachusetts General Hospital
Kumarasamy, Nagalingeswaran
India, Chennai
Yr Gaitonde Centre for Aids Research and Education
Wood, Robin Y.
South Africa, Cape Town
University of Cape Town
Noubary, Farzad
United States, Boston
Massachusetts General Hospital
Paltiel, A. David
United States, New Haven
Yale University
Nakamura, Yoriko M.
United States, Boston
Massachusetts General Hospital
Godbole, Sheela V.
India, Pune
National Aids Research Institute India
Panchia, Ravindre
South Africa, Johannesburg
Perinatal Hiv Research Unit
Sanne, Ian
South Africa, Johannesburg
Clinical Hiv Research Unit
Weinstein, Milton C.
United States, Boston
Harvard T.h. Chan School of Public Health
Losina, Elena
United States, Boston
Massachusetts General Hospital
United States, Boston
Brigham and Women's Hospital
United States, Boston
Harvard Medical School
Mayer, Kenneth H.
United States, Boston
Harvard Medical School
United States, Boston
Fenway Community Health Center
Chen, Yingqing
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
United States, Seattle
Fred Hutchinson Cancer Research Center
Wang, Lei
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
United States, Seattle
Fred Hutchinson Cancer Research Center
McCauley, Marybeth B.
United States, Durham
Fhi 360
Gamble, Theresa R.
United States, Durham
Fhi 360
Seage, George R.
United States, Boston
Harvard T.h. Chan School of Public Health
United States, Boston
Center for Biostatistics in Aids Research
Cohen, Myron S.
United States, Chapel Hill
Unc School of Medicine
Freedberg, Kenneth A.
United States, Boston
Massachusetts General Hospital
United States, Boston
Harvard Medical School
United States, Boston
Harvard T.h. Chan School of Public Health
Statistics
Citations: 64
Authors: 20
Affiliations: 16
Identifiers
Doi:
10.1056/NEJMsa1214720
ISSN:
00284793
e-ISSN:
15334406
Research Areas
Infectious Diseases
Study Locations
South Africa