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Cost-effectiveness of earlier initiation of antiretroviral therapy for uninsured HIV-infected adults

Author

Listed:
  • Schackman, B.R.
  • Goldie, S.J.
  • Weinstein, M.C.
  • Losina, E.
  • Zhang, H.
  • Freedberg, K.A.

Abstract

Objectives. This study was designed to examine the societal cost-effectiveness and the impact on government payers of earlier initiation of antiretroviral therapy for uninsured HIV-infected adults. Methods. A state-transition simulation model of HIV disease was used. Data were derived from the Multicenter AIDS Cohort Study, published randomized trials, and medical care cost estimates for all government payers and for Massachusetts, New York, and Florida. Results. Quality-adjusted life expectancy increased from 7.64 years with therapy initiated at 200 CD4 cells/μL to 8.21 years with therapy initiated at 500 CD4 cells/μL. Initiating therapy at 500 CD4/μL was a more efficient use of resources than initiating therapy at 200 CD4/μL and had an incremental cost-effectiveness ratio of $17 300 per quality-adjusted life-year gained, compared with no therapy. Costs to state payers in the first 5 years ranged from $5500 to $24900 because of differences among the states in the availability of federal funds for AIDS drug assistance programs. Conclusions. Antiretroviral therapy initiated at 500 CD4 cells/μL is cost-effective from a societal perspective compared with therapy initiated later. States should consider Medicaid waivers to expand access to early therapy.

Suggested Citation

  • Schackman, B.R. & Goldie, S.J. & Weinstein, M.C. & Losina, E. & Zhang, H. & Freedberg, K.A., 2001. "Cost-effectiveness of earlier initiation of antiretroviral therapy for uninsured HIV-infected adults," American Journal of Public Health, American Public Health Association, vol. 91(9), pages 1456-1463.
    • Handle: RePEc:aph:ajpbhl:2001:91:9:1456-1463_3
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    Cited by:

    1. Lasserre, Pierre & Moatti, Jean-Paul & Soubeyran, Antoine, 2006. "Early initiation of highly active antiretroviral therapies for AIDS: Dynamic choice with endogenous and exogenous learning," Journal of Health Economics, Elsevier, vol. 25(3), pages 579-598, May.
    2. Kit Simpson & Alvin Strassburger & Walter Jones & Birgitta Dietz & Rukmini Rajagopalan, 2009. "Comparison of Markov Model and Discrete-Event Simulation Techniques for HIV," PharmacoEconomics, Springer, vol. 27(2), pages 159-165, February.
    3. Jay Bhattacharya & Dana Goldman & Neeraj Sood, 2004. "Price Regulation in Secondary Insurance Markets," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 71(4), pages 643-675, December.
    4. Michael Kremer & Christopher M. Snyder, 2018. "Preventives Versus Treatments Redux: Tighter Bounds on Distortions in Innovation Incentives with an Application to the Global Demand for HIV Pharmaceuticals," Review of Industrial Organization, Springer;The Industrial Organization Society, vol. 53(1), pages 235-273, August.

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