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Economic and epidemiologic impact of guidelines for early ART initiation irrespective of CD4 count in Spain

Author

Listed:
  • Parastu Kasaie
  • Matthew Radford
  • Sunaina Kapoor
  • Younghee Jung
  • Beatriz Hernandez Novoa
  • David Dowdy
  • Maunank Shah

Abstract

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/mm3. 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.

Suggested Citation

  • Parastu Kasaie & Matthew Radford & Sunaina Kapoor & Younghee Jung & Beatriz Hernandez Novoa & David Dowdy & Maunank Shah, 2018. "Economic and epidemiologic impact of guidelines for early ART initiation irrespective of CD4 count in Spain," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-15, November.
    • Handle: RePEc:plo:pone00:0206755
    DOI: 10.1371/journal.pone.0206755
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    1. Oleguer Parés-Badell & Gabriela Barbaglia & Petra Jerinic & Anders Gustavsson & Luis Salvador-Carulla & Jordi Alonso, 2014. "Cost of Disorders of the Brain in Spain," PLOS ONE, Public Library of Science, vol. 9(8), pages 1-10, August.
    2. Marta Trapero-Bertran & Juan Oliva-Moreno, 2014. "Economic impact of HIV/AIDS: a systematic review in five European countries," Health Economics Review, Springer, vol. 4(1), pages 1-16, December.
    3. Bruce R. Schackman & Sue J. Goldie & Kenneth A. Freedberg & Elena Losina & John Brazier & Milton C. Weinstein, 2002. "Comparison of Health State Utilities Using Community and Patient Preference Weights Derived from a Survey of Patients with HIV/AIDS," Medical Decision Making, , vol. 22(1), pages 27-38, February.
    4. Eliazar Sabater & Armando López-Guillermo & Antonio Rueda & Antonio Salar & Itziar Oyagüez & Juan Manuel Collar, 2016. "Cost-Effectiveness Analysis of Bendamustine Plus Rituximab as a First-Line Treatment for Patients with Follicular Lymphoma in Spain," Applied Health Economics and Health Policy, Springer, vol. 14(4), pages 465-477, August.
    5. Fumiyo Nakagawa & Alec Miners & Colette J Smith & Ruth Simmons & Rebecca K Lodwick & Valentina Cambiano & Jens D Lundgren & Valerie Delpech & Andrew N Phillips, 2015. "Projected Lifetime Healthcare Costs Associated with HIV Infection," PLOS ONE, Public Library of Science, vol. 10(4), pages 1-12, April.
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