Expanding access to HAART: a cost-effective approach for treating and preventing HIV
Expanding access to HAART: a cost-effective approach for treating and preventing HIV
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DOI：
10.1097/qad.0b013e32833af85d
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发表时间：
2010-07-31
期刊：
影响因子：
3.8
通讯作者：
Montaner, Julio S.
中科院分区：
文献类型：
--
作者：
Johnston, Karissa M.;Levy, Adrian R.;Montaner, Julio S.
目标：艾滋病毒仍然是全球健康的重大负担。鉴于与该疾病相关的直接医疗费用高昂，预防新的传播是限制经济负担的一个重要因素。除了提供治疗益处外，HAART治疗还具有预防HIV传播的潜力。本研究的目的是对加拿大不列颠哥伦比亚省的HAART扩展治疗干预措施的增量净效益进行经济学评价。设计：描述HIV传播的数学模型，结合描述HIV临床和经济过程的微观模拟模型。主要结果是在不列颠哥伦比亚省将HAART治疗从50%扩大到75%的临床合格个体的增量净获益，假设愿意支付的门槛为每质量调整生命年50 000美元。直接医疗费用包括抗逆转录病毒和非抗逆转录病毒药物、住院、医生就诊和实验室检查。数学和微观模拟模型的基础上观察到的患者特征在不列颠哥伦比亚省。纵向数据描述了不列颠哥伦比亚省所有接受HIV治疗的个人的卫生服务利用、临床进展和生存情况。结果：在30年的时间里，HAART扩展方案带来了9亿美元的净效益（95%置信区间为4.93亿至14.5亿美元）。将不列颠哥伦比亚省临床合格个体的HAART治疗率从50%提高到75%似乎是基于该模式的具有成本效益的策略。这些成本效益结果与公共卫生目标一致：所有有资格接受既定救生治疗的个人都应接受治疗。（C）2010年威科健康垂直栏Lippincott威廉姆斯& Wilkins
Objective: HIV continues to present a substantial global health burden. Given the high direct medical costs associated with the disease, prevention of new transmission is an important element in limiting economic burden. In addition to providing therapeutic benefit, treatment with HAART has potential to prevent transmission of HIV. The objective in this study was to perform an economic evaluation of the incremental net benefit associated with an intervention to expand treatment with HAART in British Columbia, Canada.Design: A mathematical model describing transmission of HIV, integrated with a microsimulation model describing the clinical and economic course of HIV.Methods: The primary outcome was the incremental net benefit of expanding treatment with HAART from 50 to 75% of clinically eligible individuals in British Columbia, assuming a willingness-to-pay threshold of US$ 50 000 per quality-adjusted life year. Direct medical costs included were antiretroviral and nonantiretroviral medications, hospitalizations, physician visits, and laboratory tests. The mathematical and microsimulation models were based on patient characteristics observed in British Columbia. Longitudinal data described health services utilization, clinical progression, and survival for all individuals receiving treatment for HIV in British Columbia.Results: Over 30 years, the HAART expansion scenario was associated with a net benefit of US$ 900 million (95% confidence interval US$ 493 million to 1.45 billion).Conclusion: Increasing the HAART treatment rate from 50 to 75% of clinically eligible individuals in British Columbia appears to be a cost-effective strategy based on this model. These cost-effectiveness results are consistent with public health objectives: all individuals who are eligible for an established life-saving treatment should receive it. (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins