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The Cost-Effectiveness of Early Access to HIV Services and Starting cART in the UK 1996-2008

Lookup NU author(s): Dr Margaret Johnson, Dr Brendan McCarron, Dr Edmund Ong

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Abstract

Aim: To calculate use, cost and cost-effectiveness of people living with HIV (PLHIV) starting routine treatment and care before starting combination antiretroviral therapy (cART) and PLHIV starting first-line 2NRTIs+NNRTI or 2NRTIs+PIboosted, comparing PLHIV with CD4 <= 200 cells/mm(3) and CD4>200 cells/mm(3). Few studies have calculated the use, cost and cost-effectiveness of routine treatment and care before starting cART and starting cART above and below CD4 200 cells/mm(3). Methods: Use, costs and cost-effectiveness were calculated for PLHIV in routine pre-cART and starting first-line cART, comparing CD4 <= 200 cells/mm3 with CD4>200 cells/mm(3) (2008 UK prices). Results: cART naive patients CD4 <= 200 cells/mm(3) had an annual cost of 6,407 pound (95% CI 6,382 pound to 6,425) pound PPY compared with 2,758 pound (95% CI 2,752 pound to 2,761) pound PPY for those with CD4>200 cells/mm3; cost per life year gained of pre-cART treatment and care for those with CD4>200 cells/mm(3) was 1,776 pound (cost-saving to 2,752) pound. Annual cost for starting 2NRTIs+NNRTI or 2NRTIs+PIboosted with CD4 <= 200 cells/mm(3) was 12,812 pound (95% CI 12,685- pound 12,937) pound compared with 10,478 pound (95% CI 10,376- pound 10,581) pound for PLHIV with CD4>200 cells/mm(3). Cost per additional life-year gained on first-line therapy for those with CD4>200 cells/mm(3) was 4639 pound (3,967 pound to 2,960) pound. Conclusion: PLHIV starting to use HIV services before CD4 <= 200 cells/mm(3) is cost-effective and enables them to be monitored so they start cART with a CD4>200 cells/mm3, which results in better outcomes and is cost-effective. However, 25% of PLHIV accessing services continue to present with CD4 <= 200 cells/mm3. This highlights the need to investigate the cost-effectiveness of testing and early treatment programs for key populations in the UK.

Publication metadata

Author(s): Beck EJ, Mandalia S, Sangha R, Sharott P, Youle M, Baily G, Brettle R, Gompels M, Johnson M, McCarron B, Ong E, Pozniak A, Schwenk A, Taylor S, Walsh J, Wilkins E, Williams I, Gazzard B, NPMS-HHC Steering Grp

Publication type: Article

Publication status: Published

Journal: PLoS One

Year: 2011

Volume: 6

Issue: 12

Print publication date: 14/12/2011

Date deposited: 02/03/2012

ISSN (electronic): 1932-6203

Publisher: Public Library of Science

URL: http://dx.doi.org/10.1371/journal.pone.0027830

DOI: 10.1371/journal.pone.0027830

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