IDEAS home Printed from https://ideas.repec.org/a/eee/jhecon/v25y2006i3p579-598.html
   My bibliography  Save this article

Early initiation of highly active antiretroviral therapies for AIDS: Dynamic choice with endogenous and exogenous learning

Author

Listed:
  • Lasserre, Pierre
  • Moatti, Jean-Paul
  • Soubeyran, Antoine

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'effe
(This abstract was borrowed from another version of this item.)

Suggested Citation

  • Lasserre, Pierre & Moatti, Jean-Paul & Soubeyran, Antoine, 2006. "Early initiation of highly active antiretroviral therapies for AIDS: Dynamic choice with endogenous and exogenous learning," Journal of Health Economics, Elsevier, vol. 25(3), pages 579-598, May.
    • Handle: RePEc:eee:jhecon:v:25:y:2006:i:3:p:579-598
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0167-6296(05)00090-1
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to look for a different version below or search for a different version of it.

    Other versions of this item:

    References listed on IDEAS

    as
    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.
    2. Palmer, Stephen & Smith, Peter C., 2000. "Incorporating option values into the economic evaluation of health care technologies," Journal of Health Economics, Elsevier, vol. 19(5), pages 755-766, September.
    3. Avinash K. Dixit & Robert S. Pindyck, 1994. "Investment under Uncertainty," Economics Books, Princeton University Press, edition 1, number 5474.
    4. Schackman, B.R. & Goldie, S.J. & Weinstein, M.C. & Losina, E. & Zhang, H. & Freedberg, K.A., 2001. "Cost-effectiveness of earlier initiation of antiretroviral therapy for uninsured HIV-infected adults," American Journal of Public Health, American Public Health Association, vol. 91(9), pages 1456-1463.
    5. Kassar, Ilhem & Lasserre, Pierre, 2004. "Species preservation and biodiversity value: a real options approach," Journal of Environmental Economics and Management, Elsevier, vol. 48(2), pages 857-879, September.
    6. Geoffard, Pierre-Yves & Philipson, Tomas, 1996. "Rational Epidemics and Their Public Control," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 37(3), pages 603-624, August.
    7. Giuseppe Moscarini & Lones Smith, 2001. "The Optimal Level of Experimentation," Econometrica, Econometric Society, vol. 69(6), pages 1629-1644, November.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. 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.
    2. 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.
    3. 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.
    4. 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.
    5. 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.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Rosella Levaggi & Michele Moretto & Vincenzo Rebba, 2009. "Investment decisions in hospital technology when physicians are devoted workers," Economics of Innovation and New Technology, Taylor & Francis Journals, vol. 18(5), pages 487-512.
    2. Ben Abdallah, Skander & Lasserre, Pierre, 2016. "Asset retirement with infinitely repeated alternative replacements: Harvest age and species choice in forestry," Journal of Economic Dynamics and Control, Elsevier, vol. 70(C), pages 144-164.
    3. Th'eo Durandard & Matteo Camboni, 2024. "Comparative Statics for Optimal Stopping Problems in Nonstationary Environments," Papers 2402.06999, arXiv.org, revised Jul 2024.
    4. Paolo Pertile, 2008. "Investment in Health Technologies in a Competitive Model with Real Options," Journal of Public Economic Theory, Association for Public Economic Theory, vol. 10(5), pages 923-952, October.
    5. Décamps, Jean-Paul & Mariotti, Thomas & Villeneuve, Stéphane, 2000. "Investment Timing under Incomplete Information," IDEI Working Papers 115, Institut d'Économie Industrielle (IDEI), Toulouse, revised Apr 2004.
    6. 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.
    7. Anastasios Michailidis & Konstadinos Mattas & Irene Tzouramani & Diamantis Karamouzis, 2009. "A Socioeconomic Valuation of an Irrigation System Project Based on Real Option Analysis Approach," Water Resources Management: An International Journal, Published for the European Water Resources Association (EWRA), Springer;European Water Resources Association (EWRA), vol. 23(10), pages 1989-2001, August.
    8. Sebastian Sund & Lars H. Sendstad & Jacco J. J. Thijssen, 2022. "Kalman filter approach to real options with active learning," Computational Management Science, Springer, vol. 19(3), pages 457-490, July.
    9. Lukach, R. & Kort, P.M. & Plasmans, J.E.J., 2005. "Optimal R&D Investment Strategies with Quantity Competition under the Threat of Superior Entry," Other publications TiSEM f41be61a-5422-43b2-9080-0, Tilburg University, School of Economics and Management.
    10. Luca Corato & Michele Moretto & Sergio Vergalli, 2013. "Land conversion pace under uncertainty and irreversibility: too fast or too slow?," Journal of Economics, Springer, vol. 110(1), pages 45-82, September.
    11. Louberge, Henri & Villeneuve, Stephane & Chesney, Marc, 2002. "Long-term risk management of nuclear waste: a real options approach," Journal of Economic Dynamics and Control, Elsevier, vol. 27(1), pages 157-180, November.
    12. Ben Abdallah, Skander & Lasserre, Pierre, 2012. "A real option approach to the protection of a habitat dependent endangered species," Resource and Energy Economics, Elsevier, vol. 34(3), pages 295-318.
    13. Siddhartha Bandyopadhyay & Kalyan Chatterjee & Kaustav Das & Jaideep Roy, 2020. "Learning or habit formation? Optimal timing of lockdown for disease containment," Discussion Papers 20-17, Department of Economics, University of Birmingham.
    14. 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.
    15. Marc Chesney & Pierre Lasserre & Bruno Troja, 2017. "Mitigating global warming: a real options approach," Annals of Operations Research, Springer, vol. 255(1), pages 465-506, August.
    16. Strand, Jon, 2017. "Modeling the marginal value of rainforest losses: A dynamic value function approach," Ecological Economics, Elsevier, vol. 131(C), pages 322-329.
    17. Marc Baudry & Béatrice Dumont, 2009. "A Bayesian Real Option Approach to Patents and Optimal Renewal Fees," Working Papers hal-00419330, HAL.
    18. Martin Forster & Paolo Pertile, 2013. "Optimal decision rules for HTA under uncertainty: a wider, dynamic perspective," Health Economics, John Wiley & Sons, Ltd., vol. 22(12), pages 1507-1514, December.
    19. Jörgen Hellström & Niklas Rudholm, 2010. "Uncertainty in the generic versus brand name prescription decision," Empirical Economics, Springer, vol. 38(3), pages 503-521, June.
    20. 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.

    More about this item

    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

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:jhecon:v:25:y:2006:i:3:p:579-598. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/locate/inca/505560 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.