Early initiation of highly active antiretroviral therapies for AIDS: Dynamic choice with endogenous and exogenous learning
AbstractCriteria for initiation of highly active antiretroviral treatments (HAART) in HIV-infected patients remain a matter of debate world-wide because short-term benefits have to be balanced with costs of these therapies, and restrictions placed on future treatment options if resistant viral strains develop. On the other hand, postponing the introduction of HAART may involve a therapeutic opportunity cost if a patientâs health is allowed to deteriorate to such an extent of becoming unable to benefit from new treatments currently under development when they become available. We introduce a two period model where period one treatment adoption is an irreversible act with future, but uncertain, consequences. New information, both endogenous and exogenous, arises over time and shapes the conditions surrounding the second period therapeutic decision. A surprising result is that, under conditions that appear close to those surrounding the HAART debate, the magnitude of the feared resistance effect has no effect on leaves the optimal treatment decision as far as it is high enough. Le bien-fondÃ© dâadministrer prÃ©cocement des traitements antirÃ©troviraux Ã haute activitÃ© (HAART) aux personnes infectÃ©es par le VIH reste objet de dÃ©bats dans le monde, car leurs bienfaits Ã court terme peuvent compromettre les traitements futurs si se dÃ©veloppent des souches rÃ©sistantes du virus. Par ailleurs retarder le recours aux HAART comporte un coÃ»t dâopportunitÃ© thÃ©rapeutique si la santÃ© du patient se dÃ©grade au point quâil ne peut plus bÃ©nÃ©ficier par la suite des traitements encore en cours de dÃ©veloppement. Nous formulons un modÃ¨le Ã deux pÃ©riodes oÃ¹ lâadoption du traitement de premiÃ¨re pÃ©riode est irrÃ©versible et engage le futur, alors que des informations et connaissances nouvelles, exogÃ¨nes et endogÃ¨nes, dÃ©terminent les conditions entourant la dÃ©cision thÃ©rapeutique de deuxiÃ¨me pÃ©riode. Paradoxalement, sous des conditions reflÃ©tant bien les enjeux
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Bibliographic InfoArticle provided by Elsevier in its journal Journal of Health Economics.
Volume (Year): 25 (2006)
Issue (Month): 3 (May)
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Web page: http://www.elsevier.com/locate/inca/505560
Other versions of this item:
- Pierre Lasserre & Jean-Paul Moatti & Antoine Soubeyran, 2005. "Early Initiation of Highly Active Antiretroviral Therapies for Aids: Dynamic choice with Endogenous and Exogenous Learning," CIRANO Working Papers 2005s-34, CIRANO.
- I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
- C61 - Mathematical and Quantitative Methods - - Mathematical Methods; Programming Models; Mathematical and Simulation Modeling - - - Optimization Techniques; Programming Models; Dynamic Analysis
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