HIV Treatment as Prevention: Modelling the Cost of Antiretroviral Treatment—State of the Art and Future Directions

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Policy discussions about the feasibility of massively scaling up antiretroviral therapy (ART) to reduce HIV transmission and incidence hinge on accurately projecting the cost of such scale-up in comparison to the benefits from reduced HIV incidence and mortality. We review the available literature on modelled estimates of the cost of providing ART to different populations around the world, and suggest alternative methods of characterising cost when modelling several decades into the future. In past economic analyses of ART provision, costs were often assumed to vary by disease stage and treatment regimen, but for treatment as prevention, in particular, most analyses assume a uniform cost per patient. This approach disregards variables that can affect unit cost, such as differences in factor prices (i.e., the prices of supplies and services) and the scale and scope of operations (i.e., the sizes and types of facilities providing ART). We discuss several of these variables, and then present a worked example of a flexible cost function used to determine the effect of scale on the cost of a proposed scale-up of treatment as prevention in South Africa. Adjusting previously estimated costs of universal testing and treatment in South Africa for diseconomies of small scale, i.e., more patients being treated in smaller facilities, adds 42% to the expected future cost of the intervention.

Vyšlo v časopise: HIV Treatment as Prevention: Modelling the Cost of Antiretroviral Treatment—State of the Art and Future Directions. PLoS Med 9(7): e32767. doi:10.1371/journal.pmed.1001247
Kategorie: Review
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1001247

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1. GilliamBLDyerJRFiscusSAMarcusCZhouS 1997 Effects of reverse transcriptase inhibitor therapy on HIV-1 viral burden in semen. J Acquir Immune Defic Syndr 15 54 60

2. MontanerJSGLimaVDBarriosRYipBWoodE 2010 Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population-based study. Lancet 376 532 539

3. CohenMChenYQMcCauleyMGambleTHosseinipourMC 2011 Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med 365 493 505

4. GranichRMGilksCFDyeCDe CockKMWilliamsBG 2009 Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet 373 48 57

5. HontelezJACde VlasSJTanserFBakkerRBärnighausenT 2011 The impact of the new WHO antiretroviral treatment guidelines on HIV epidemic dynamics and cost in South Africa. PLoS ONE 6 e21919 doi:10.1371/journal.pone.0021919

6. WagnerBBlowerS 2010 Costs of eliminating HIV in South Africa have been underestimated. Lancet 376 953

7. EatonJWJohnsonLFSalomonJABärnighausenTBendavidE 2012 HIV treatment as prevention: systematic comparison of mathematical models of the potential impact of antiretroviral therapy on HIV incidence in South Africa. PLoS Med 9 e1001245 doi:10.1371/journal.pmed.1001245

8. WilsonDP 2012 HIV treatment as prevention: natural experiments highlight limits of antiretroviral treatment as HIV prevention. PLoS Med 9 e1001231 doi:10.1371/journal.pmed.1001231

9. DelvaWEatonJWMengFFraserCWhiteRG 2012 HIV treatment as prevention: optimising the impact of expanded HIV treatment programmes. PLoS Med 9 e1001258 doi:10.1371/journal.pmed.1001258

10. BärnighausenTSalomonJASangrujeeN 2012 HIV treatment as prevention: issues in economic evaluation. PLoS Med 9 e1001263 doi:10.1371/journal.pmed.1001263

11. YouleMTruemanPSimpsonK 1999 Health economics in HIV disease. A review of the European literature. Phamacoeconomics 15 Suppl 1 1 12

12. BeckEJMinersAHYolleyK 2001 The cost of HIV treatment and care: a global review. Phamacoeconomics 19 13 39

13. BeckEJHarlingGGerbaseSDeLayP 2010 The cost of treatment and care for people living with HIV infection: implications of published studies, 1999–2008. Curr Opin HIV AIDS 5 215 224

14. BollingerLAdesinaA 2011 Review of available ART costs, major cost drivers and potential efficiency gains [presentation]. UNAIDS Economics Reference Group; 7–8 March 2011; Geneva, Switzerland

15. GalárragaOWirtzVJFiguero-LaraASanta-Ana-TellezYCoulibalyI 2011 Unit costs for delivery of antiretroviral treatment and prevention of mother-to-child transmission of HIV. A systematic review for low- and middle-income countries. Pharmacoeconomics 29 579 599

16. OddoneECowperPHamiltonJMatcharDBHartiganP 1993 Cost effectiveness analysis of early zidovudine treatment of HIV infected patients. BMJ 307 1322 1325

17. SchulmanKLynneLGlickHEisenbergJ 1991 Cost-effectiveness of low-dose zidovudine therapy for asymptomatic patients with human immunodeficiency virus (HIV) infection. Ann Intern Med 114 798 801

18. DaviesDCarneCCamilleri-FerranteC 1999 Combined antiviral treatment in HIV infection. Is it value for money? Public Health 113 315 317

19. ChancellorJVHillAMSabinCASimpsonKNYouleM 1997 Modelling the cost effectiveness of lamivudine/zidovudine combination therapy in HIV infection. Pharmacoeconomics 12 54 66

20. MauskopfJLaceyLKempelASimpsonK 1998 The cost-effectiveness of treatment with lamivudine and zidovudine compared with zidovudine alone: a comparison of Markov model and trial data estimates. Am J Manag Care 4 1004 1012

21. SimpsonKHatziandreuEJAnderssonFShakespeareAOleksyI 1994 Cost effectiveness of antiviral treatment with zalcitabine plus zidovudine for AIDS patients with CD4+ counts less than 300/microliters in 5 European countries. Pharmacoeconomics 6 553 562

22. BiddleAKSimpsonKN 2000 Modeling the use of triple combination therapy in five countries: nevirapine, zidovudine, and didanosine. Value Health 3 186 201

23. SendiPPBucherHHarrTCraigBASchwietertM 1999 Cost effectiveness of highly active antiretroviral therapy in HIV-infected patients. AIDS 13 1115 1122

24. CookJDasbachECoplanPMarksonLYinD 1999 Modeling the long-term outcomes and costs of HIV antiretroviral therapy using HIV RNA levels: applications to a clinical trial. AIDS Res Hum Retroviruses 15 499 508

25. TruemanPYouleMSabinCAMinersAHBeckEJ 2000 The cost-effectiveness of triple nucleoside analogue therapy antiretroviral regimens in the treatment of HIV in the United Kingdom. HIV Clin Trials 1 27 35

26. MinersASabinCTruemanPYouleMMocroftA 2001 Assessing the cost-effectiveness of highly active antiretroviral therapy for adults with HIV in England. HIV Med 2 52 58

27. KahnJGHaileBKatesJChangS 2001 Health and federal budgetary effects of increasing access to antiretroviral medications for HIV by expanding Medicaid. Am J Public Health 91 1464 1473

28. RisebroughNOhPRachlisAMcMurchyDBastM 1999 Economic evaluation of triple ART with indinavir or abacavir and ZDV+3TC compared to dual therapy ZDV+3TC [abstract]. 6th Conference on Retroviruses and Opportunistic Infections; 31 Jan–4 Feb 1999; Chicago, Illinois, US

29. CaroJO'BrienJMiglaccio-WalleKRaggioG 2001 Economic analysis of initial HIV treatment: efavirenz- versus indinavir-containing triple therapy. Pharmacoeconomics 19 95 104

30. SchackmanBRFreedbergKAWeinsteinMCSaxPELosinaE 2002 Cost-effectiveness implications of the timing of antiretroviral therapy in HIV-infected adults. Arch Intern Med 162 2478 2486

31. SchackmanBRGoldieSJWeinsteinMCLosinaEZhangH 2001 Cost-effectiveness of earlier initiation of antiretroviral therapy for uninsured HIV-infected adults. Am J Public Health 91 1456 1463

32. YazdanpanahYGoldieSLosinaEWeinsteinMCLebrunT 2002 Lifetime cost of HIV care in France during the era of highly active antiretroviral therapy. Antivir Ther 7 257 266

33. FreedbergKALosinaEWeinsteinMCPaltielDCohenC 2001 The cost effectiveness of combination antiretroviral therapy for HIV disease. N Engl J Med 344 824 831

34. MauskopfJATolsonJMSimpsonKNPhamSVAlbrightJ 2000 Impact of zidovudine-based triple combination therapy on an AIDS drug assistance program. J Acquir Immune Defic Syndr 23 302 313

35. MooreRDBartlettJ 1996 Combination antiretroviral therapy in HIV infection: an economic perspective. Pharmacoeconomics 10 109 113

36. SimpsonKNLuoMPChumneyESunEBrunS 2004 Cost-effectiveness of lopinavir/ritonavir versus nelfinavir as the first-line highly active antiretroviral therapy regimen for HIV infection. HIV Clin Trials 5 294 304

37. MunakataJSandersGOwensDBayoumiA 2003 Cost effectiveness of enfuvirtide in the treatment of drug-resistant HIV infection. Med Decis Making 23 569

38. SnedecorSHartzemaASchillerK 2005 Cost effectiveness of HIV treatment innovations of greater efficacy than highly active antiretroviral therapy (HAART). Value Health 8 244

39. SaxPLosinaEWeinsteinMPaltielAGoldieS 2005 Cost-effectiveness of enfuvirtide in treatment-experienced patients with advanced HIV disease. J Acquir Immune Defic Syndr 39 69 77

40. LongEBrandeauMGalvinCVinichenkoTToleS 2006 Effectiveness and cost-effectiveness of strategies to expand antiretroviral therapy in St. Petersburg, Russia. AIDS 20 2207 2215

41. GoldieSYazdanpanahYLosinaEWeinsteinMAnglaretX 2006 Cost-effectiveness of HIV treatment in resource-poor settings—the case of Cote d'Ivoire. N Engl J Med 355 1141 1153

42. PatonNChapmanCSangeethaSMandaliaSBellamyR 2006 Cost and cost-effectiveness of antiretroviral therapy for HIV infection in Singapore. Int J STD AIDS 17 699 705

43. ClearySMcIntyreDBoulleA 2006 The cost-effectiveness of antiretroviral treatment. Cost Eff Resour Alloc 4 20

44. OverMRevengaAMsasakiEPeerapatanapokinWGoldJ 2007 The economics of effective AIDS treatment in Thailand. AIDS 21 Suppl 4 S105 S116

45. WalenskyRPWoodRCiaranelloALPaltielADLorenzanaSB 2010 Scaling up the 2010 World Health Organization HIV treatment guidelines in resource-limited settings: a model-based analysis. PLoS Med 7 e1000382 doi:10.1371/journal.pmed.1000382

46. BendavidEGrantPTalbotAOwensDKZolopaA 2011 Cost-effectiveness of antiretroviral regimens in the World Health Organization's treatment guidelines: a South African analysis. AIDS 25 211 220

47. CiaranelloALLockmanSFreedbergKAHughesMChuJ 2011 First-line antiretroviral therapy after single-dose nevirapine exposure in South Africa: a cost-effectiveness analysis of the OCTANE trial. AIDS 25 479 492

48. BachmannMO 2006 Effectiveness and cost effectiveness of early and late prevention of HIV/AIDS progression with antiretrovirals or antibiotics in Southern African adults. AIDS Care 18 109 120

49. BonnelR 2000 Costs of scaling HIV program activities to a national level in sub-Saharan Africa: methods and estimates Washington (District of Columbia) World Bank

50. KumaranayakeLContehLKurowskiCWattsC 2001 Preliminary estimates of the cost of expanding TB, malaria and HIV/AIDS activities for sub-Saharan Africa Geneva Working Group 5, WHO Commission on Macroeconomics and Health

51. CreeseAFloydKAlbanAGuinnessL 2002 Cost-effectiveness of HIV/AIDS interventions in Africa: a systematic review of the evidence. Lancet 359 1635 1642

52. HoganDRBaltussenRHayashiCLauerJASalomonJA 2005 Achieving the millennium development goals for health: cost effectiveness analysis of strategies to combat HIV/AIDS in developing countries. BMJ 331 1431 1437 doi:10.1136/bmj.38643.368692.68

53. FloydKGilksC 1997 Cost and financing aspects of providing antiretroviral therapy. Van PraagEFernyakSMartin KatzA The implications of antiretroviral treatments. Informal consultation. World Health Organization, Office of HIV/AIDS and Sexually Transmitted Diseases Geneva World Health Organization

54. HoggRWeberACraibKAslamAO'ShaughnessyM 1998 One world, one hope: the cost of providing antiretroviral therapy to all nations. AIDS 12 2203 2209

55. AttaranASachsJ 2001 Defining and refining international donor support for combating the AIDS epidemic. Lancet 357 57 61

56. SchwartländerBStoverJWalkerNBollingerLMcGreeveyW 2001 Resource needs for HIV/AIDS. Science 292 2434 2436

57. GutierrezJJohnsBAdamTBertozziSMEdejerTT 2004 Achieving the WHO/UNAIDS antiretroviral treatment 3 by 5 goal: what will it cost? Lancet 364 63 64

58. StoverJKorenrompEBlakleyMKomatsuRViisainenK 2011 Long-term costs and health impact of continued global fund support for antiretroviral therapy. PLoS ONE 6 e21048 doi:10.1371/journal.pone.0021048

59. ReschSKorenrompEStoverJBlakleyMKrubinerC 2011 Economic returns to investment in AIDS treatment in low and middle income countries. PLoS ONE 6 e25310 doi:10.1371/journal.pone.0025310

60. SchwartländerBStoverJHallettTAtunRAvilaC 2011 Towards an improved investment approach for an effective response to HIV/AIDS. Lancet 377 2031 2041

61. LongEFBrandeauMLOwensDK 2010 The cost-effectiveness and population outcomes of expanded HIV screening and antiretroviral treatment in the United States. Ann Intern Med 153 778 789

62. OverMHeywoodPGoldJGuptaIHiraS 2004 HIV/AIDS treatment and prevention in India: modeling the costs and consequences Washington (District of Columbia) The International Bank for Reconstruction and Development/The World Bank

63. VijayaraghavanAEfrusyMBMazonsonPDEbrahimOSanneIM 2007 Cost effectiveness of alternative strategies for initiating and monitoring highly active antiretroviral therapy in the developing world. J Acquir Immune Defic Syndr 46 91 100

64. LongLFoxMSanneIRosenS 2010 The high cost of second-line antiretroviral therapy for HIV/AIDS in South Africa. AIDS 24 915 919

65. BrennanAMeyer-RathGFoxMModisenyaneTMartisonN 2011 Rates and cost of hospitalization before and after initiation of antiretroviral therapy in South Africa [abstract]. International Workshop on HIV Observational Databases; 24–26 March 2011; Prague, Czech Republic

66. KrentzHBAuldMCGillMJ 2004 The high cost of medical care for patients who present late (CD4 <200 cells/microL) with HIV infection. HIV Med 5 93 98

67. NykampDBarnettCWLagoMParhamDLFernandezES 1997 Cost of medication therapy in ambulatory HIV-infected patients. Ann Pharmacother 31 303 307

68. LeisegangRClearySHislopMDavidseARegensbergL 2009 Early and late direct costs in a Southern African antiretroviral treatment programme: a retrospective cohort analysis. PLoS Med 6 e1000189 doi:10.1371/journal.pmed.1000189

69. Perez-CasasCHerranzEFordN 2001 Pricing of drugs and donations: options for sustainable equity pricing. Trop Med Int Health 6 960 964

70. World Trade Organization 2001 Declaration on the TRIPS agreement and public health. WT/MIN(01)/DEC/2

71. Médecins Sans Frontières Campaign for Access to Essential Medicines 2008 Untangling the web of antiretroviral price reductions, 11th edition Geneva Médecins Sans Frontières

72. Joint United Nations Programme on HIV/AIDS 2011 Toward an improved framework for HIV investments Geneva Joint United Nations Programme on HIV/AIDS

73. MarseilleEDandonaLMarshallNGaistPBautista-ArradondoS 2007 HIV prevention cost and program scale: data from the PANCEA project in five low and middle-income countries. BMC Health Serv Res 7 108

74. GuinnessLKumaranayakeLRajaramanBSankaranarayananGVannelaG 2005 Does scale matter? The costs of HIV-prevention interventions for commercial sex workers in India. Bull World Health Organ 83 747 755

75. GuinnessLKumaranayakeLHansonK 2007 A cost function for HIV prevention services: is there a ‘u’-shape? Cost Eff Resour Alloc 5 13

76. JohnsBBaltussenR 2004 Accounting for the cost of scaling-up health interventions. Health Econ 13 1117 1124

77. MenziesNABerrutiAABerzonRFillerSFerrisR 2011 The cost of providing comprehensive HIV treatment in PEPFAR-supported programs. AIDS 25 1753 1760

78. RosenSLongLSanneI 2008 The outcomes and outpatient costs of different models of antiretroviral treatment delivery in South Africa. Trop Med Int Health 13 1005 1015

79. KabugoCBahendekaSMwebazeRMalambaSKatuntuD 2005 Long-term experience providing antiretroviral drugs in a fee-for-service HIV clinic in Uganda. Evidence of extended virologic and CD4+ cell count responses. J Acquir Immune Defic Syndr 38 578 583

80. LeonardKLMasatuMC 2010 Professionalism and the know-do gap: exploring intrinsic motivation among health workers in Tanzania. Health Econ 19 1461 1477

81. DasJHammerJLeonardK 2008 The quality of medical advice in low-income countries. J Econ Perspect 22 93 114

82. Republic of South Africa 2010 Country progress report on the declaration of commitment on HIV/AIDS. 2010 Report Pretoria Republic of South Africa

83. ZipfGK 1935 The psychobiology of language Boston Houghton-Mifflin