Cost-effectiveness and budget impact of immediate antiretroviral therapy initiation for treatment of HIV infection in Cote d'Ivoire: A model-based analysis
| dc.rights.license | open | en_US |
| hal.structure.identifier | Bordeaux population health [BPH] | |
| dc.contributor.author | OUATTARA, Eric | |
| dc.contributor.author | MACLEAN, R. L. | |
| hal.structure.identifier | Bordeaux population health [BPH] | |
| dc.contributor.author | DANEL, Christine | |
| dc.contributor.author | BORRE, E. D. | |
| hal.structure.identifier | Bordeaux population health [BPH] | |
| dc.contributor.author | GABILLARD, Delphine | |
| dc.contributor.author | HUANG, M. | |
| dc.contributor.author | MOH, Desmorys Raoul | |
| dc.contributor.author | PALTIEL, A. D. | |
| dc.contributor.author | EHOLIE, S. P. | |
| dc.contributor.author | WALENSKY, R. P. | |
| hal.structure.identifier | Bordeaux population health [BPH] | |
| dc.contributor.author | ANGLARET, Xavier | |
| dc.contributor.author | FREEDBERG, K. A. | |
| dc.date.accessioned | 2020-07-09T08:55:00Z | |
| dc.date.available | 2020-07-09T08:55:00Z | |
| dc.date.issued | 2019 | |
| dc.identifier.issn | 1932-6203 | en_US |
| dc.identifier.uri | https://oskar-bordeaux.fr/handle/20.500.12278/10259 | |
| dc.description.abstractEn | INTRODUCTION: The Temprano and START trials provided evidence to support early ART initiation recommendations. We projected long-term clinical and economic outcomes of immediate ART initiation in Cote d'Ivoire. METHODS: We used a mathematical model to compare three potential ART initiation criteria: 1) CD4 <350/muL (ART<350/muL); 2) CD4 <500/muL (ART<500/muL); and 3) ART at presentation (Immediate ART). Outcomes from the model included life expectancy, 10-year medical resource use, incremental cost-effectiveness ratios (ICERs) in $/year of life saved (YLS), and 5-year budget impact. We simulated people with HIV (PWH) in care (mean CD4: 259/muL, SD 198/muL) and transmitted cases. Key input parameters to the analysis included first-line ART efficacy (80% suppression at 6 months) and ART cost ($90/person-year). We assessed cost-effectiveness relative to Cote d'Ivoire's 2017 per capita annual gross domestic product ($1,600). RESULTS: Immediate ART increased life expectancy by 0.34 years compared to ART<350/muL and 0.17 years compared to ART<500/muL. Immediate ART resulted in 4,500 fewer 10-year transmissions per 170,000 PWH compared to ART<350/muL. In cost-effectiveness analysis, Immediate ART had a 10-year ICER of $680/YLS compared to ART<350/muL, ranging from cost-saving to an ICER of $1,440/YLS as transmission rates varied. ART<500/muL was "dominated" (an inefficient use of resources), compared with Immediate ART. Immediate ART increased the 5-year HIV care budget from $801.9M to $812.6M compared to ART<350/muL. CONCLUSIONS: In Cote d'Ivoire, immediate compared to later ART initiation will increase life expectancy, decrease HIV transmission, and be cost-effective over the long-term, with modest budget impact. Immediate ART initiation is an appropriate, high-value standard of care in Cote d'Ivoire and similar settings. | |
| dc.language.iso | EN | en_US |
| dc.rights | Attribution 3.0 United States | |
| dc.rights.uri | https://creativecommons.org/licenses/by/3.0/us/ | |
| dc.subject.en | IDLIC | |
| dc.title.en | Cost-effectiveness and budget impact of immediate antiretroviral therapy initiation for treatment of HIV infection in Cote d'Ivoire: A model-based analysis | |
| dc.title.alternative | PLoS One | en_US |
| dc.type | Article de revue | en_US |
| dc.identifier.doi | 10.1371/journal.pone.0219068 | en_US |
| dc.subject.hal | Sciences du Vivant [q-bio]/Santé publique et épidémiologie | en_US |
| dc.identifier.pubmed | 31247009 | en_US |
| bordeaux.journal | PLoS ONE | en_US |
| bordeaux.page | e0219068 | en_US |
| bordeaux.volume | 14 | en_US |
| bordeaux.hal.laboratories | Bordeaux Population Health Research Center (BPH) - U1219 | en_US |
| bordeaux.issue | 6 | en_US |
| bordeaux.institution | Université de Bordeaux | en_US |
| bordeaux.peerReviewed | oui | en_US |
| bordeaux.inpress | non | en_US |
| hal.identifier | hal-02894743 | |
| hal.version | 1 | |
| hal.date.transferred | 2020-07-09T08:55:06Z | |
| hal.export | true | |
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