TY - JOUR
T1 - Economic and epidemiologic impact of guidelines for early ART initiation irrespective of CD4 count in Spain
AU - Kasaie, Parastu
AU - Radford, Matthew
AU - Kapoor, Sunaina
AU - Jung, Younghee
AU - Novoa, Beatriz Hernandez
AU - Dowdy, David
AU - Shah, Maunank
N1 - Publisher Copyright:
© 2018 Kasaie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2018/11
Y1 - 2018/11
N2 - Introduction Emerging data suggest that early antiretroviral therapy (ART) could reduce serious AIDS and non-AIDS events and deaths but could also increase costs. In January 2016, the Spanish guidelines were updated to recommend ART at any CD4 count. However, the epidemiologic and economic impacts of early ART initiation in Spain remain unclear. Methods The Johns Hopkins HIV Economic-Epidemiologic Mathematical Model (JHEEM) was utilized to estimate costs, transmissions, and outcomes in Spain over 20 years. We compared implementation of guidelines for early ART initiation to a counterfactual scenario deferring ART until CD4-counts fall below 350 cells/mm 3 . We additionally studied the impact of early ART initiation in combination with improvements to HIV screening, care linkage and engagement. Results Early ART initiation (irrespective of CD4-count) is expected to avert 20,100 [95% Uncertainty Range (UR) 11,100–83,000] new HIV cases over the next two decades compared to delayed ART (28% reduction), at an incremental health system cost of €1.05 billion [€0.66 – €1.63] billion, and an incremental cost-effectiveness ratio (ICER) of €29,700 [€13,700 – €41,200] per QALY gained. Projected ICERs declined further over longer time horizon; e.g., an ICER of €12,691 over 30 years. Furthermore, the impact of early ART initiation was potentiated by improved HIV screening among high-risk individuals, averting an estimated 41,600 [23,200–172,200] HIV infections (a 58% decline) compared to delayed ART. Conclusions Recommendations for ART initiation irrespective of CD4-counts are cost-effective and could avert > 30% of new cases in Spain. Improving HIV diagnosis can amplify this impact.
AB - Introduction Emerging data suggest that early antiretroviral therapy (ART) could reduce serious AIDS and non-AIDS events and deaths but could also increase costs. In January 2016, the Spanish guidelines were updated to recommend ART at any CD4 count. However, the epidemiologic and economic impacts of early ART initiation in Spain remain unclear. Methods The Johns Hopkins HIV Economic-Epidemiologic Mathematical Model (JHEEM) was utilized to estimate costs, transmissions, and outcomes in Spain over 20 years. We compared implementation of guidelines for early ART initiation to a counterfactual scenario deferring ART until CD4-counts fall below 350 cells/mm 3 . We additionally studied the impact of early ART initiation in combination with improvements to HIV screening, care linkage and engagement. Results Early ART initiation (irrespective of CD4-count) is expected to avert 20,100 [95% Uncertainty Range (UR) 11,100–83,000] new HIV cases over the next two decades compared to delayed ART (28% reduction), at an incremental health system cost of €1.05 billion [€0.66 – €1.63] billion, and an incremental cost-effectiveness ratio (ICER) of €29,700 [€13,700 – €41,200] per QALY gained. Projected ICERs declined further over longer time horizon; e.g., an ICER of €12,691 over 30 years. Furthermore, the impact of early ART initiation was potentiated by improved HIV screening among high-risk individuals, averting an estimated 41,600 [23,200–172,200] HIV infections (a 58% decline) compared to delayed ART. Conclusions Recommendations for ART initiation irrespective of CD4-counts are cost-effective and could avert > 30% of new cases in Spain. Improving HIV diagnosis can amplify this impact.
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U2 - 10.1371/journal.pone.0206755
DO - 10.1371/journal.pone.0206755
M3 - Article
C2 - 30395635
AN - SCOPUS:85056228153
SN - 1932-6203
VL - 13
JO - PloS one
JF - PloS one
IS - 11
M1 - e0206755
ER -