Cost-Effectiveness of Early HIV Therapy in Haiti
Author Information
Author(s): Serena P. Koenig, Heejung Bang, Patrice Severe, Marc Antoine Jean Juste, Alex Ambroise, Alison Edwards, Jessica Hippolyte, Daniel W. Fitzgerald, Jolion McGreevy, Cynthia Riviere, Serge Marcelin, Rode Secours, Warren D. Johnson, Jean W. Pape, Bruce R. Schackman
Primary Institution: Groupe Haitien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port au Prince, Haiti
Hypothesis
Is early antiretroviral therapy (ART) cost-effective compared to standard ART in HIV-infected adults in Haiti?
Conclusion
Early ART is cost-effective in Haiti when following the new WHO guidelines for treatment initiation.
Supporting Evidence
- Early ART decreased mortality by 75% compared to standard ART.
- The cost-effectiveness ratio for early ART was US$3,975/YLS including research-related tests.
- Excluding research-related tests, the cost-effectiveness ratio was US$2,050/YLS.
- Mean total costs per patient were US$1,381 for early ART and US$1,033 for standard ART.
- Early ART patients had higher costs for ART but lower costs for non-ART medications.
Takeaway
Starting HIV treatment earlier can save lives and is a good use of money in Haiti.
Methodology
A randomized clinical trial comparing early versus standard ART in HIV-infected adults with CD4 counts between 200 and 350 cells/mm3.
Potential Biases
Potential biases due to the trial setting and adherence differences compared to non-trial settings.
Limitations
The study only followed participants for a maximum of 3 years and did not account for long-term benefits of early treatment.
Participant Demographics
Median age 40 years, 58% women, 39% had secondary education or higher, 63% earned less than $100 per year.
Statistical Information
P-Value
p=0.0011
Confidence Interval
95% CI US$2,129/YLS–US$9,979/YLS
Statistical Significance
p<0.0001
Digital Object Identifier (DOI)
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