Cost-effectiveness of HIV treatment in resource-poor settings - The case of Cote d'Ivoire
Cost-effectiveness of HIV treatment in resource-poor settings - The case of Cote d'Ivoire
复制标题
DOI：
10.1056/nejmsa060247
复制
发表时间：
2006-09-14
影响因子：
158.5
通讯作者：
Freedberg, Kenneth A.
中科院分区：
文献类型：
--
作者：
Goldie, Sue J.;Yazdanpanah, Yazdan;Freedberg, Kenneth A.
背景：随着抗逆转录病毒治疗越来越多地在资源有限的环境中使用，必须解决有关治疗时机和使用诊断测试来指导临床决策的关键问题。方法：我们评估了科特迪瓦一组感染人类免疫缺陷病毒（HIV）的成年人（平均年龄33岁；CD4细胞计数为331 /立方毫米；HIV RNA水平为5.3 log拷贝/毫升）治疗策略的成本效益。使用基于计算机的模拟模型，将CD4细胞计数和HIV RNA水平作为疾病进展的预测因子，我们比较了不治疗、单独使用甲氧苄氨嘧啶-磺胺甲恶唑预防、单独使用抗逆转录病毒治疗和预防与抗逆转录病毒治疗相关的长期临床和经济结果。结果：与单独使用甲氧苄氨嘧啶-磺胺甲恶唑预防相比，未经折扣的预期寿命增长范围从抗逆转录病毒治疗和基于临床标准的预防的10.7个月到抗逆转录病毒治疗和基于CD4检测和临床标准的预防的45.9个月不等。与第二种最便宜的策略相比，每年获得的生命增量成本分别为单独预防240美元（以2002年美元计算），抗逆转录病毒治疗和不进行CD4检测的预防620美元，抗逆转录病毒治疗和进行CD4检测的预防1180美元。单独使用抗逆转录病毒治疗的策略都不如同时使用甲氧苄氨嘧啶-磺胺甲恶唑预防的策略具有成本效益。在一线治疗方案失败后，使用第二线抗逆转录病毒治疗，预期寿命增加了30%。结论：甲氧苄啶-磺胺甲恶唑预防和抗逆转录病毒治疗策略，单独使用临床标准或结合CD4检测来指导治疗时机，在资源有限的环境中是一项具有经济吸引力的卫生投资。
BACKGROUND:As antiretroviral therapy is increasingly used in settings with limited resources, key questions about the timing of treatment and use of diagnostic tests to guide clinical decisions must be addressed.METHODS:We assessed the cost-effectiveness of treatment strategies for a cohort of adults in Cote d'Ivoire who were infected with the human immunodeficiency virus (HIV) (mean age, 33 years; CD4 cell count, 331 per cubic millimeter; HIV RNA level, 5.3 log copies per milliliter). Using a computer-based simulation model that incorporates the CD4 cell count and HIV RNA level as predictors of disease progression, we compared the long-term clinical and economic outcomes associated with no treatment, trimethoprim-sulfamethoxazole prophylaxis alone, antiretroviral therapy alone, and prophylaxis with antiretroviral therapy.RESULTS:Undiscounted gains in life expectancy ranged from 10.7 months with antiretroviral therapy and prophylaxis initiated on the basis of clinical criteria to 45.9 months with antiretroviral therapy and prophylaxis initiated on the basis of CD4 testing and clinical criteria, as compared with trimethoprim-sulfamethoxazole prophylaxis alone. The incremental cost per year of life gained was $240 (in 2002 U.S. dollars) for prophylaxis alone, $620 for antiretroviral therapy and prophylaxis without CD4 testing, and $1,180 for antiretroviral therapy and prophylaxis with CD4 testing, each compared with the next least expensive strategy. None of the strategies that used antiretroviral therapy alone were as cost-effective as those that also used trimethoprim-sulfamethoxazole prophylaxis. Life expectancy was increased by 30% with use of a second line of antiretroviral therapy after failure of the first-line regimen.CONCLUSIONS:A strategy of trimethoprim-sulfamethoxazole prophylaxis and antiretroviral therapy, with the use of clinical criteria alone or in combination with CD4 testing to guide the timing of treatment, is an economically attractive health investment in settings with limited resources.