Cost Effectiveness of the National HIV/AIDS Strategy Goal of Increasing Linkage to Care for HIV-Infected Persons
Cost Effectiveness of the National HIV/AIDS Strategy Goal of Increasing Linkage to Care for HIV-Infected Persons
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DOI：
10.1097/qai.0b013e31825bd862
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发表时间：
2012-09-01
影响因子：
3.6
通讯作者：
Sansom, Stephanie L.
中科院分区：
文献类型：
--
作者：
Gopalappa, Chaitra;Farnham, Paul G.;Sansom, Stephanie L.
背景：国家艾滋病毒/艾滋病战略(NHAS)的目标之一是将艾滋病毒感染者在确诊后3个月内接受护理的比例(早期联系)从65%提高到85%。更早地获得护理，并最终获得治疗，可提高艾滋病毒感染者的预期寿命和生活质量。然而，治疗时间越长，成本也越高，尤其是抗逆转录病毒药物。我们评估了实现NHAS目标的成本效益，并估计了艾滋病毒项目在与护理相联系并保持成本效益方面可能花费的最大成本。方法：我们使用艾滋病毒/艾滋病的进展和传播模型来估计将早期与护理相联系从65%增加到85%对生活指标和成本的影响。我们估计了一个增量成本-效果比，即达到目标所需的额外成本除以获得的质量调整寿命年(QALY)，并假设每个QALY获得的成本不超过10万美元的计划是具有成本效益的。结果：实现NHAS与护理挂钩的目标使每个HIV确诊患者的预期寿命平均增加0.4年，并将艾滋病的发病延迟1.2年。增加早期联系到护理的成本每增加一个QALY额外62,200美元，只考虑到对指标人的好处。在早期与护理相关联的干预措施上，最高可花费的成本效益约为每人5100美元。结论：为实现NHAS的早期与护理相关联的目标，可以进行大量的成本效益投资。
Background: One of the goals of the National HIV/AIDS Strategy (NHAS) is to increase the proportion of HIV-infected individuals linked to care within 3 months of diagnosis (early linkage) from 65% to 85%. Earlier access to care, and eventually, to treatment, increases life expectancy and quality of life for HIV-infected persons. However, longer treatment is also associated with higher costs, especially for antiretroviral drugs. We evaluated the cost effectiveness of achieving the NHAS goal and estimated the maximum cost that HIV programs could spend on linkage to care and remain cost effective.Methods: We used the Progression and Transmission of HIV/AIDS model to estimate the effects on life measures and costs associated with increasing early linkage to care from 65% to 85%. We estimated an incremental cost-effectiveness ratio as the additional cost required to reach the target divided by the quality-adjusted life years (QALYs) gained and assumed that programs costing $100,000 or less per QALY gained are cost effective.Results: Achieving the NHAS linkage-to-care goal increased life expectancy by 0.4 years and delayed the onset of AIDS by 1.2 years on average for every HIV-diagnosed person. Increasing early linkage to care cost an extra $62,200 per QALY gained, considering only benefits to index persons. The maximum that could be cost effectively spent on early linkage-to-care interventions was approximately $5100 per HIV-diagnosed person.Conclusions: Considerable investment can be cost effectively made to achieve the NHAS goal on early linkage to care.