Changing the South African national antiretroviral therapy guidelines: The role of cost modelling.
Changing the South African national antiretroviral therapy guidelines: The role of cost modelling.
复制标题
DOI：
10.1371/journal.pone.0186557
复制
发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Rosen S
中科院分区：
文献类型：
--
作者：
Meyer-Rath G;Johnson LF;Pillay Y;Blecher M;Brennan AT;Long L;Moultrie H;Sanne I;Fox MP;Rosen S
南非卫生部委托我们评估采用世界卫生组织在2010年至2016年期间发布的抗逆转录病毒治疗指南对世界上最大的抗逆转录病毒治疗规划的成本影响。利用来自南非大型ART诊所（n = 24,244例患者）的数据、需要ART的患者预测以及自下而上成本分析的成本数据，我们构建了一个人口水平的健康状态转换模型，根据患者的年龄、CD4细胞计数/百分比以及成人一线ART的治疗时间，该模型在健康状态之间进行了6个月的转换。对于每一套指南，由于流行和接受而导致的患者数量的模型增加大大超过了额外资格所带来的增加。根据每一套指南，预计未来7年接受抗逆转录病毒治疗的人数将增加31-133%，费用将增加84-175%，而资格的增加导致患者增加1-26%，费用增加1-17%。2010年和2015年世卫组织指南导致的预计治疗费用增加可通过采取诸如开放药物招标进行国际竞争和任务转移等节省成本的措施全部抵消。在普遍治疗下，治疗方案的年度费用将从2024年起首次下降。南非用于抗逆转录病毒治疗的年度预算需求将继续增加，直到全面普及治疗为止。模型结果在改变南非抗逆转录病毒治疗指南方面发挥了重要作用，在2009年至2017年期间，接受治疗的人数增加了两倍多，并将每位患者的治疗费用降低了64%。
We were tasked by the South African Department of Health to assess the cost implications to the largest ART programme in the world of adopting sets of ART guidelines issued by the World Health Organization between 2010 and 2016. Using data from large South African ART clinics (n = 24,244 patients), projections of patients in need of ART, and cost data from bottom-up cost analyses, we constructed a population-level health-state transition model with 6-monthly transitions between health states depending on patients’ age, CD4 cell count/ percentage, and, for adult first-line ART, time on treatment. For each set of guidelines, the modelled increase in patient numbers as a result of prevalence and uptake was substantially more than the increase resulting from additional eligibility. Under each set of guidelines, the number of people on ART was projected to increase by 31–133% over the next seven years, and cost by 84–175%, while increased eligibility led to 1–26% more patients, and 1–17% higher cost. The projected increases in treatment cost due to the 2010 and the 2015 WHO guidelines could be offset in their entirety by the introduction of cost-saving measures such as opening the drug tenders for international competition and task-shifting. Under universal treatment, annual costs of the treatment programme will decrease for the first time from 2024 onwards. Annual budgetary requirements for ART will continue to increase in South Africa until universal treatment is taken to full scale. Model results were instrumental in changing South African ART guidelines, more than tripling the population on treatment between 2009 and 2017, and reducing the per-patient cost of treatment by 64%.
登录
查看更多内容
影响因子：
120.7
作者：
Bolton-Moore, Carolyn;Mubiana-Mbewe, Mwangelwa;Stringer, Jeffrey S. A.
通讯作者：
Stringer, Jeffrey S. A.
影响因子：
3.8
作者：
Long, Lawrence;Fox, Matthew;Rosen, Sydney
通讯作者：
Rosen, Sydney
影响因子：
3.3
作者：
Rosen, Sydney;Long, Lawrence;Sanne, Ian
通讯作者：
Sanne, Ian
DOI：
10.1097/qai.0b013e31827e8785
发表时间：
2013-03-01
影响因子：
3.6
作者：
Meyer-Rath, Gesine;Brennan, Alana T.;Martinson, Neil
通讯作者：
Martinson, Neil
影响因子：
15.8
作者：
Leisegang R;Cleary S;Hislop M;Davidse A;Regensberg L;Little F;Maartens G
通讯作者：
Maartens G