Cost effectiveness of combination HIV therapy - 3 years later

被引:50
作者
Moore, RD [1 ]
机构
[1] Johns Hopkins Univ, Sch Med, Baltimore, MD 21205 USA
关键词
D O I
10.2165/00019053-200017040-00002
中图分类号
F [经济];
学科分类号
02 ;
摘要
Since 1997, expert panel guidelines for HIV care have recommended the use of combination antiretroviral therapy with at least 3 antiretroviral drugs. Several studies have examined the cost effectiveness of 3-drug combination antiretroviral regimens for the treatment of HIV infection. Analyses comparing a 3-drug protease inhibitor-containing regimen with a 1- or 2-drug non-nucleoside reverse transcriptase inhibitor regimen have consistently yielded incremental direct cost estimates ranging from SUS 10 000 to just over $US 13 000 per year of life saved. In Western societies, such an incremental cost per year of life saved compares favourably with chronic therapy for other diseases and argues for the adoption of these drugs by payers and policy makers. The reason for this favourable cost-effectiveness ratio appears to be the decrease in opportunistic complications and hospitalisation associated with the effective use of combination antiretroviral therapy. Whether this initial benefit will be maintained is nor yet known. Other comorbid illnesses such as hepatitis C or renal failure may subsequently increase the cost of HIV care, and some analyses suggest that resistance may develop to these drugs over the long term. In addition, studies are needed to assess the cost effectiveness of these therapies in developing countries where the expense of these drugs appears to put them out of reach. The collection and analysis of economic data will continue to be needed as newer HIV therapies become available and the HIV healthcare environment evolves. Quantifying medical care costs and calculating cost effectiveness involve assessing a moving target. Economic analyses of HIV infection must evolve in tandem with therapeutic changes to continue to be relevant to policy makers, payers of can, and those who provide and receive HIV care.
引用
收藏
页码:325 / 330
页数:6
相关论文
共 31 条
[1]   Modelling the potential economic impact of viral load-driven triple drug combination antiretroviral therapy [J].
Anis, AH ;
Hogg, RS ;
Wang, XH ;
Yip, B ;
Palepu, A ;
Montaner, JSG ;
O'Shaughnessy, MV ;
Schechter, MT .
PHARMACOECONOMICS, 1998, 13 (06) :697-705
[2]  
[Anonymous], 1998, MMWR Recomm Rep, V47, P1
[3]   Antiretroviral therapy for HIV infection in 1996 - Recommendations of an international panel [J].
Carpenter, CCJ ;
Fischl, MA ;
Hammer, SM ;
Hirsch, MS ;
Jacobsen, DM ;
Katzenstein, DA ;
Montaner, JSG ;
Richman, DD ;
Saag, MS ;
Schooley, RT ;
Thompson, MA ;
Vella, S ;
Yeni, PG ;
Volberding, PA .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1996, 276 (02) :146-154
[4]   Modelling the cost effectiveness of lamivudine/zidovudine combination therapy in HIV infection [J].
Chancellor, JV ;
Hill, AM ;
Sabin, CA ;
Simpson, KN ;
Youle, M .
PHARMACOECONOMICS, 1997, 12 (01) :54-66
[5]   Modeling the long-term outcomes and costs of HIV Antiretroviral therapy using HIV RNA levels: Application to a clinical trial [J].
Cook, J ;
Dasbach, E ;
Coplan, P ;
Markson, L ;
Yin, DP ;
Meibohm, A ;
Nguyen, BY ;
Chodakewitz, J ;
Mellors, J .
AIDS RESEARCH AND HUMAN RETROVIRUSES, 1999, 15 (06) :499-508
[6]  
FORSYTHE S, 1998, 12 INT AIDS C JUN 28
[7]  
FREEDBERG KA, 1999, P 39 INT C ANT AG CH
[8]  
GULICK R, 1999, 6 C RETR OPP INF JAN
[9]   Treatment with indinavir, zidovudine, and lamivudine in adults with human immunodeficiency virus infection and prior antiretroviral therapy [J].
Gulick, RM ;
Mellors, JW ;
Havlir, D ;
Eron, JJ ;
Gonzalez, C ;
McMahon, D ;
Richman, DD ;
Valentine, FT ;
Jonas, L ;
Meibohm, A ;
Emini, EA ;
Chodakewitz, JA .
NEW ENGLAND JOURNAL OF MEDICINE, 1997, 337 (11) :734-739
[10]   A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic millimeter or less [J].
Hammer, SM ;
Squires, KE ;
Hughes, MD ;
Grimes, JM ;
Demeter, LM ;
Currier, JS ;
Eron, JJ ;
Feinberg, JE ;
Balfour, HH ;
Dayton, LR ;
Chodakewitz, JA ;
Fischl, MA .
NEW ENGLAND JOURNAL OF MEDICINE, 1997, 337 (11) :725-733