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Early Initiation of Highly Active Antiretroviral Therapies for Aids: Dynamic choice with Endogenous and Exogenous Learning

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  • Pierre Lasserre
  • Jean-Paul Moatti
  • Antoine Soubeyran

Abstract

Criteria 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 patient's 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-fondé d'administrer précocement des traitements antirétroviraux à haute activité (HAART) aux personnes infectées par le VIH reste objet de débats dans le monde, car leurs bienfaits à court terme peuvent compromettre les traitements futurs si se développent des souches résistantes du virus. Par ailleurs retarder le recours aux HAART comporte un coût d'opportunité thérapeutique si la santé du patient se dégrade au point qu'il ne peut plus bénéficier par la suite des traitements encore en cours de développement. Nous formulons un modèle à deux périodes où l'adoption du traitement de première période est irréversible et engage le futur, alors que des informations et connaissances nouvelles, exogènes et endogènes, déterminent les conditions entourant la décision thérapeutique de deuxième période. Paradoxalement, sous des conditions reflétant bien les enjeux du recours aux HAART, il s'avère que l'effet résistance éventuel a d'autant moins de chance d'importer pour la décision optimale, que sa gravité est élevée.

Suggested Citation

  • 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.
    • Handle: RePEc:cir:cirwor:2005s-34
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    References listed on IDEAS

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    1. Rosella Levaggi & Moretto Michele, 2008. "Investment In Hospital Care Technology Under Different Purchasing Rules: A Real Option Approach," Bulletin of Economic Research, Wiley Blackwell, vol. 60(2), pages 159-181, April.
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    Cited by:

    1. Paolo Pertile, 2009. "An extension of the real option approach to the evaluation of health care technologies: the case of positron emission tomography," International Journal of Health Economics and Management, Springer, vol. 9(3), pages 317-332, September.
    2. Felipa, de Mello-Sampayo, 2014. "The Timing and Probability of Switching to Second-line Regimen - An application to Second-Line Antiretroviral Therapy in India," MPRA Paper 60997, University Library of Munich, Germany.
    3. Paolo Pertile & Emanuele Torri & Luciano Flor & Stefano Tardivo, 2009. "The timing of adoption of positron emission tomography: a real options approach," Health Care Management Science, Springer, vol. 12(3), pages 217-227, September.
    4. Leoni, Patrick & Luchini, Stéphane, 2011. "Designing the financial tools to promote universal access to AIDS care," Journal of Health Economics, Elsevier, vol. 30(1), pages 181-188, January.
    5. Meyer, Elisabeth & Rees, Ray, 2012. "Watchfully waiting: Medical intervention as an optimal investment decision," Journal of Health Economics, Elsevier, vol. 31(2), pages 349-358.

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    More about this item

    Keywords

    therapeutic decisions; uncertainty; information; irreversibility; treatment; endogenous learning; exogenous learning; décisions thérapeutiques; incertitude; information; irréversibilité; traitement; apprentissage endogène; apprentissage exogène;
    All these keywords.

    JEL classification:

    • 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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