Cost-effectiveness of early treatment with first-line NNRTI-based HAART regimens in the UK, 1996-2006

Beck, Eduard J, Mandalia, Sundhiya, Lo, Gary, Sharott, Peter, Youle, Mike, Anderson, Jane, Baily, Guy, Brettle, Ray, Fisher, Martin, Gompels, Mark, Kinghorn, George, Johnson, Margaret, McCarron, Brendan, Pozniak, Anton, Tang, Alan, Walsh, John, White, David, Williams, Ian, Gazzard, Brian and The NPMS-HHC Steering Group, (2011) Cost-effectiveness of early treatment with first-line NNRTI-based HAART regimens in the UK, 1996-2006. PloS One, 6 (5). e20200. ISSN 1932-6203

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Abstract

AIM

Calculate time to first-line treatment failure, annual cost and cost-effectiveness of NNRTI versus PIboosted first-line HAART regimens in the UK, 1996-2006.

BACKGROUND

Population costs for HIV services are increasing in the UK and interventions need to be effective and efficient to reduce or stabilize costs. 2NRTIs + NNRTI regimens are cost-effective regimens for first-line HAART, but these regimens have not been compared with first-line PI(boosted) regimens.

METHODS

Times to first-line treatment failure and annual costs were calculated for first-line HAART regimens by CD4 count when starting HAART (2006 UK prices). Cost-effectiveness of 2NRTIs+NNRTI versus 2NRTIs+PI(boosted) regimens was calculated for four CD4 strata.

RESULTS

55% of 5,541 people living with HIV (PLHIV) started HAART with CD4 count ≤ 200 cells/mm3, many of whom were Black Africans. Annual treatment cost decreased as CD4 count increased; most marked differences were observed between starting HAART with CD4 ≤ 200 cells/mm3 compared with CD4 count >200 cells/mm3. 2NRTI+PI(boosted) and 2NRTI+NNRTI regimens were the most effective regimens across the four CD4 strata; 2NRTI + NNRTI was cost-saving or cost-effective compared with 2NRTI + PI(boosted) regimens.

CONCLUSION

To ensure more effective and efficient provision of HIV services, 2NRTI+NNRTI should be started as first-line HAART regimen at CD4 counts ≤ 350 cell/mm3, unless specific contra-indications exist. This will increase the number of PLHIV receiving HAART and will initially increase population costs of providing HIV services. However, starting PLHIV earlier on cost-effective regimens will maintain them in better health and use fewer health or social services, thereby generating fewer treatment and care costs, enabling them to remain socially and economically active members of society. This does raise a number of ethical issues, which will have to be acknowledged and addressed, especially in countries with limited resources.

Item Type: Article
Schools and Departments: Brighton and Sussex Medical School > Brighton and Sussex Medical School
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine > RA0643 Communicable diseases and public health > RA0644 Individual diseases or groups of diseases, A-Z > RA0644.A25 AIDS. HIV infections
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Depositing User: Ellen Thomas
Date Deposited: 14 Feb 2014 12:20
Last Modified: 14 Mar 2017 11:06
URI: http://sro.sussex.ac.uk/id/eprint/47511

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