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

Beck EJ, Mandalia S, Lo G, Sharott P, Youle M, Anderson J, Baily G, Brettle R, Fisher M, Gompels M, Kinghorn G, Johnson M, McCarron B, Pozniak A, Tang A, Walsh J, White D, Williams I, Gazzard B, NPMS-HHC Steering Gro - PLoS ONE (2011)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: NPMS-HHC Coordinating and Analytic Centre, London, United Kingdom. becke@unaids.org

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.

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Proportion of people starting HAART at CD4 count 201 – 350                            cells/mm3 who failed first-line therapy and time to treatment failure                            (days) comparing 2NRTIs+NNRTI with 2NRTIs+PIboosted                            first-line regimens.
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pone-0020200-g003: Proportion of people starting HAART at CD4 count 201 – 350 cells/mm3 who failed first-line therapy and time to treatment failure (days) comparing 2NRTIs+NNRTI with 2NRTIs+PIboosted first-line regimens.

Mentions: When CD4 counts were stratified into four strata, the 2NRTIs + PIboosted regimens had a longer estimated time to first-line failure compared with 2NRTIs + NNRTI regimens only for those PLHIV who started HAART with a CD4 count between 101–200 cell/mm3. For the other three strata, the 2NRTIs + NNRTI regimens had similar or longer estimated times to first-line failure (Table 2; Figures 1–4). In addition to the impact of the antiretroviral drugs, women, younger people and those with an AIDS diagnosis were all more likely to fail first-line therapy (Table 2).


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

Beck EJ, Mandalia S, Lo G, Sharott P, Youle M, Anderson J, Baily G, Brettle R, Fisher M, Gompels M, Kinghorn G, Johnson M, McCarron B, Pozniak A, Tang A, Walsh J, White D, Williams I, Gazzard B, NPMS-HHC Steering Gro - PLoS ONE (2011)

Proportion of people starting HAART at CD4 count 201 – 350                            cells/mm3 who failed first-line therapy and time to treatment failure                            (days) comparing 2NRTIs+NNRTI with 2NRTIs+PIboosted                            first-line regimens.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3102104&req=5

pone-0020200-g003: Proportion of people starting HAART at CD4 count 201 – 350 cells/mm3 who failed first-line therapy and time to treatment failure (days) comparing 2NRTIs+NNRTI with 2NRTIs+PIboosted first-line regimens.
Mentions: When CD4 counts were stratified into four strata, the 2NRTIs + PIboosted regimens had a longer estimated time to first-line failure compared with 2NRTIs + NNRTI regimens only for those PLHIV who started HAART with a CD4 count between 101–200 cell/mm3. For the other three strata, the 2NRTIs + NNRTI regimens had similar or longer estimated times to first-line failure (Table 2; Figures 1–4). In addition to the impact of the antiretroviral drugs, women, younger people and those with an AIDS diagnosis were all more likely to fail first-line therapy (Table 2).

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: NPMS-HHC Coordinating and Analytic Centre, London, United Kingdom. becke@unaids.org

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.

Show MeSH