Cost-effectiveness of early treatment with first-line NNRTI-based HAART regimens in the UK, 1996-2006 |
| |
Authors: | Beck Eduard J Mandalia Sundhiya Lo Gary Sharott Peter Youle Mike Anderson Jane Baily Guy Brettle Ray Fisher Martin Gompels Mark Kinghorn George Johnson Margaret McCarron Brendan Pozniak Anton Tang Alan Walsh John White David Williams Ian Gazzard Brian;NPMS-HHC Steering Group |
| |
Institution: | NPMS-HHC Coordinating and Analytic Centre, London, United Kingdom. becke@unaids.org |
| |
Abstract: | AimCalculate time to first-line treatment failure, annual cost and
cost-effectiveness of NNRTI versus PIboosted first-line HAART regimens in
the UK, 1996–2006.BackgroundPopulation costs for HIV services are increasing in the UK and interventions
need to be effective and efficient to reduce or stabilize costs. 2NRTIs
+ NNRTI regimens are cost-effective regimens for first-line HAART, but
these regimens have not been compared with first-line PIboosted
regimens.MethodsTimes to first-line treatment failure and annual costs were calculated for
first-line HAART regimens by CD4 count when starting HAART (2006 UK prices).
Cost-effectiveness of 2NRTIs+NNRTI versus
2NRTIs+PIboosted regimens was calculated for four CD4
strata.Results55% of 5,541 people living with HIV (PLHIV) started HAART with CD4
count ≤200 cells/mm3, many of whom were Black Africans. Annual treatment
cost decreased as CD4 count increased; most marked differences were observed
between starting HAART with CD4 ≤200 cells/mm3 compared with CD4 count
>200 cells/mm3. 2NRTI+PIboosted and 2NRTI+NNRTI
regimens were the most effective regimens across the four CD4 strata;
2NRTI+NNRTI was cost-saving or cost-effective compared with 2NRTI
+ PIboosted regimens.ConclusionTo ensure more effective and efficient provision of HIV services,
2NRTI+NNRTI should be started as first-line HAART regimen at CD4 counts
≤350 cell/mm3, unless specific contra-indications exist. This will
increase the number of PLHIV receiving HAART and will initially increase
population costs of providing HIV services. However, starting PLHIV earlier
on cost-effective regimens will maintain them in better health and use fewer
health or social services, thereby generating fewer treatment and care
costs, enabling them to remain socially and economically active members of
society. This does raise a number of ethical issues, which will have to be
acknowledged and addressed, especially in countries with limited
resources. |
| |
Keywords: | |
本文献已被 PubMed 等数据库收录! |
|