Catàleg general VIH/sida
Economic and epidemiologic impact of early ART initiation in Spain
Resum
Objectives: Emerging data suggests reductions in serious AIDS and non-AIDS events/death with early ART initiation compared to a strategy of deferral to lower CD4 thresholds. Consequently, Spanish guidelines have recently recommended ART initiation in all people living with HIV (PLWH) regardless of CD4 cell count. This strategy could improve morbidity and decrease transmission, but increase costs. We sought to quantify the economic and epidemiologic impact of early ART initiation compared to delayed treatment in Spain. Methods: The Johns Hopkins HIV Economic-Epidemiologic Mathematical Model was utilized to estimate costs, transmissions, and outcomes in Spain over 20 years. We compared implementation of guidelines for early ART at any CD4 count, to a counter-factual scenario in which ART is deferred until CD4 counts less than 350 cells/mm3. Primary outcomes were health system costs, serious clinical events (AIDS and non-AIDS events), incident cases, deaths, and Quality Adjusted Life-Years (QALY). Future costs and QALYs were discounted. Results: The updated Spanish recommendations to initiate treatment for all PLWH are expected to avert 21,500 new HIV cases over the next two decades compared to delayed ART (25% reduction), at an incremental health system cost of €839million, resulting in an incremental cost-effectiveness ratio of €28700 per QALY-gained. Our results also suggest improved health for PLWH; early ART initiation would avert over 10700 serious AIDS and non-AIDS events and avoid 3600 deaths in the coming 20 years. In secondary analysis, the impact of early ART initiation was enhanced by improved HIV diagnosis. If high-risk groups were screened for HIV annually, we found early ART initiation could reduce new transmissions by 50% (46600 HIV infections averted). Conclusion: New recommendations for early ART initiation are cost-effective and could avert 25% of new cases in Spain. Improving the HIV care continuum will amplify this impact.- Tema:
Autoria:
KASAIE, Parastu; KAPOOR, Sunaina; RADFORD, Matthew; DOWDY, David; SHAH, Maunank
Autoria institucional: Johns Hopkins School of Medicine
Autoria institucional: Johns Hopkins School of Medicine
Fitxa bibliogràfica
- Any de publicació:
- [2017]
- Descripció física:
- [9] p.
- Format:
- Fulletó
- Tipus de document:
- Col·loquis i ponències
- Notes:
- Trabajo presentado en la 16th European AIDS Conference celebrada en Milán (Italia) del 25 al 27 de octubre de 2017.
- Més informació:
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