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The Cost-Effectiveness of Early Access to HIV Services and Starting cART in the UK 1996–2008

Author

Listed:
  • Eduard J Beck
  • Sundhiya Mandalia
  • Roshni Sangha
  • Peter Sharott
  • Mike Youle
  • Guy Baily
  • Ray Brettle
  • Mark Gompels
  • Margaret Johnson
  • Brendan McCarron
  • Ed Ong
  • Anton Pozniak
  • Achim Schwenk
  • Stephen Taylor
  • John Walsh
  • Ed Wilkins
  • Ian Williams
  • Brian Gazzard
  • for the NPMS-HHC Steering Group

Abstract

Aim: To calculate use, cost and cost-effectiveness of people living with HIV (PLHIV) starting routine treatment and care before starting combination antiretroviral therapy (cART) and PLHIV starting first-line 2NRTIs+NNRTI or 2NRTIs+PIboosted, comparing PLHIV with CD4≤200 cells/mm3 and CD4>200 cells/mm3. Few studies have calculated the use, cost and cost-effectiveness of routine treatment and care before starting cART and starting cART above and below CD4 200 cells/mm3. Methods: Use, costs and cost-effectiveness were calculated for PLHIV in routine pre-cART and starting first-line cART, comparing CD4≤200 cells/mm3 with CD4>200 cells/mm3 (2008 UK prices). Results: cART naïve patients CD4≤200 cells/mm3 had an annual cost of £6,407 (95%CI £6,382 to £6,425) PPY compared with £2,758 (95%CI £2,752 to £2,761) PPY for those with CD4>200 cells/mm3; cost per life year gained of pre-cART treatment and care for those with CD4>200 cells/mm3 was £1,776 (cost-saving to £2,752). Annual cost for starting 2NRTIs+NNRTI or 2NRTIs+PIboosted with CD4≤200 cells/mm3 was £12,812 (95%CI £12,685–£12,937) compared with £10,478 (95%CI £10,376–£10,581) for PLHIV with CD4>200 cells/mm3. Cost per additional life-year gained on first-line therapy for those with CD4>200 cells/mm3 was £4639 (£3,967 to £2,960). Conclusion: PLHIV starting to use HIV services before CD4≤200 cells/mm3 is cost-effective and enables them to be monitored so they start cART with a CD4>200 cells/mm3, which results in better outcomes and is cost-effective. However, 25% of PLHIV accessing services continue to present with CD4≤200 cells/mm3. This highlights the need to investigate the cost-effectiveness of testing and early treatment programs for key populations in the UK.

Suggested Citation

  • Eduard J Beck & Sundhiya Mandalia & Roshni Sangha & Peter Sharott & Mike Youle & Guy Baily & Ray Brettle & Mark Gompels & Margaret Johnson & Brendan McCarron & Ed Ong & Anton Pozniak & Achim Schwenk &, 2011. "The Cost-Effectiveness of Early Access to HIV Services and Starting cART in the UK 1996–2008," PLOS ONE, Public Library of Science, vol. 6(12), pages 1-9, December.
    • Handle: RePEc:plo:pone00:0027830
    DOI: 10.1371/journal.pone.0027830
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    Cited by:

    1. Sonya J Snedecor & Alexandra Khachatryan & Katherine Nedrow & Richard Chambers & Congyu Li & Seema Haider & Jennifer Stephens, 2013. "The Prevalence of Transmitted Resistance to First-Generation Non-Nucleoside Reverse Transcriptase Inhibitors and Its Potential Economic Impact in HIV-Infected Patients," PLOS ONE, Public Library of Science, vol. 8(8), pages 1-1, August.

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