HIV treatment as prevention: issues in economic evaluation.
HIV treatment as prevention: issues in economic evaluation.
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DOI：
10.1371/journal.pmed.1001263
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发表时间：
2012
期刊：
影响因子：
15.8
通讯作者：
Sangrujee N
中科院分区：
文献类型：
--
作者：
Bärnighausen T;Salomon JA;Sangrujee N
Meyer-Rath和Over在2012年7月PLoS Medicine Collection的另一篇文章中断言，“调查治疗对新的HIV感染的影响”，在现有项目和HIV治疗预防（TasP）项目中，抗逆转录病毒疗法（ART）的经济评估应该使用成本函数，该成本函数可以捕获成本对许多因素的依赖性，例如交付的规模和范围，健康状况，抗逆转录病毒疗法方案、卫生工作者的经验、患者接受治疗的时间以及公共和私营部门的交付分布。我们认为，对于特定的评估目的（例如，建立TasP的社会价值）和从特定的角度（例如，国家卫生政策制定者）不太详细的成本函数可能就足够了。然后，我们扩展的经济评估TasP的讨论，描述为什么ART的结果和成本评估目前现有的计划是不可能概括到TasP程序的几个根本原因。首先，为了实现频繁、广泛的艾滋病毒检测和艾滋病毒诊断后立即接受抗逆转录病毒治疗，TasP方案将需要目前抗逆转录病毒治疗方案中不存在的组成部分，其费用也不包括在目前的估计中。其次，TasP下的ART早期启动不仅会改变患者的病程和治疗经验-这可能会影响决定临床治疗成功的行为，如ART依从性和保留-而且还会改变HIV感染者的生活质量和经济结果。第三，TasP的预防作用可能会随着时间的推移改变艾滋病毒感染人群的组成，改变其生物和行为特征，并导致ART的不同成本和结果。
Meyer-Rath and Over assert in another article in the July 2012 PLoS Medicine Collection, “Investigating the Impact of Treatment on New HIV Infections”, that economic evaluations of antiretroviral therapy (ART) in currently existing programs and in HIV treatment as prevention (TasP) programs should use cost functions that capture cost dependence on a number of factors, such as scale and scope of delivery, health states, ART regimens, health workers' experience, patients' time on treatment, and the distribution of delivery across public and private sectors. We argue that for particular evaluation purposes (e.g., to establish the social value of TasP) and from particular perspectives (e.g., national health policy makers) less detailed cost functions may be sufficient. We then extend the discussion of economic evaluation of TasP, describing why ART outcomes and costs assessed in currently existing programs are unlikely to be generalizable to TasP programs for several fundamental reasons. First, to achieve frequent, widespread HIV testing and high uptake of ART immediately following an HIV diagnosis, TasP programs will require components that are not present in current ART programs and whose costs are not included in current estimates. Second, the early initiation of ART under TasP will change not only patients' disease courses and treatment experiences—which can affect behaviors that determine clinical treatment success, such as ART adherence and retention—but also quality of life and economic outcomes for HIV-infected individuals. Third, the preventive effects of TasP are likely to alter the composition of the HIV-infected population over time, changing its biological and behavioral characteristics and leading to different costs and outcomes for ART.
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