Elisa F Long

The Cost-Effectiveness and Population Outcomes of Expanded HIV Screening and Antiretroviral Treatment in the United States

BACKGROUND Although recent guidelines call for expanded routine screening for HIV, resources for antiretroviral therapy (ART) are limited, and all eligible persons are not currently receiving treatment. OBJECTIVE To evaluate the effects on the U.S. HIV epidemic of expanded ART, HIV screening, or interventions to reduce risk behavior. DESIGN Dynamic mathematical model of HIV transmission and disease progression and cost-effectiveness analysis. DATA SOURCES Published literature. TARGET POPULATION High-risk (injection drug users and men who have sex with men) and low-risk persons aged 15 to 64 years in the United States. TIME HORIZON Twenty years and lifetime (costs and quality-adjusted life-years [QALYs]). PERSPECTIVE Societal. INTERVENTION Expanded HIV screening and counseling, treatment with ART, or both. OUTCOME MEASURES New HIV infections, discounted costs and QALYs, and incremental cost-effectiveness ratios. RESULTS OF BASE-CASE ANALYSIS One-time HIV screening of low-risk persons coupled with annual screening of high-risk persons could prevent 6.7% of a projected 1.23 million new infections and cost

Effectiveness and cost-effectiveness of strategies to expand antiretroviral therapy in St. Petersburg, Russia.

22,382 per QALY gained, assuming a 20% reduction in sexual activity after screening. Expanding ART utilization to 75% of eligible persons prevents 10.3% of infections and costs

Comparative Survival and Cost Effectiveness of Advanced Therapies for End-stage Heart Failure

20,300 per QALY gained. A combination strategy prevents 17.3% of infections and costs

Controlling Co-Epidemics: Analysis of HIV and Tuberculosis Infection Dynamics

21,580 per QALY gained. RESULTS OF SENSITIVITY ANALYSIS With no reduction in sexual activity, expanded screening prevents 3.7% of infections. Earlier ART initiation when a CD4 count is greater than 0.350 × 10(9) cells/L prevents 20% to 28% of infections. Additional efforts to halve high-risk behavior could reduce infections by 65%. LIMITATION The model of disease progression and treatment was simplified, and acute HIV screening was excluded. CONCLUSION Expanding HIV screening and treatment simultaneously offers the greatest health benefit and is cost-effective. However, even substantial expansion of HIV screening and treatment programs is not sufficient to markedly reduce the U.S. HIV epidemic without substantial reductions in risk behavior. PRIMARY FUNDING SOURCE National Institute on Drug Abuse, National Institutes of Health, and Department of Veterans Affairs.

The cost-effectiveness of symptom-based testing and routine screening for acute HIV infection in men who have sex with men in the USA.

Objective:To assess the effectiveness and cost-effectiveness of treating HIV-infected injection drug users (IDUs) and non-IDUs in Russia with highly active antiretroviral therapy HAART. Design and methods:A dynamic HIV epidemic model was developed for a population of IDUs and non-IDUs. The location for the study was St. Petersburg, Russia. The adult population aged 15 to 49 years was subdivided on the basis of injection drug use and HIV status. HIV treatment targeted to IDUs and non-IDUs, and untargeted treatment interventions were considered. Health care costs and quality-adjusted life years (QALYs) experienced in the population were measured, and HIV prevalence, HIV infections averted, and incremental cost-effectiveness ratios of different HAART strategies were calculated. Results:With no incremental HAART programs, HIV prevalence reached 64% among IDUs and 1.7% among non-IDUs after 20 years. If treatment were targeted to IDUs, over 40 000 infections would be prevented (75% among non-IDUs), adding 650 000 QALYs at a cost of US

Cost-effectiveness of elective induction of labor at 41 weeks in nulliparous women

1501 per QALY gained. If treatment were targeted to non-IDUs, fewer than 10 000 infections would be prevented, adding 400 000 QALYs at a cost of US

HIV Screening via Fourth-Generation Immunoassay or Nucleic Acid Amplification Test in the United States: A Cost-Effectiveness Analysis

2572 per QALY gained. Untargeted strategies prevented the most infections, adding 950 000 QALYs at a cost of US

Potential population health outcomes and expenditures of HIV vaccination strategies in the United States.

1827 per QALY gained. Our results were sensitive to HIV transmission parameters. Conclusions:Expanded use of antiretroviral therapy in St. Petersburg, Russia would generate enormous population-wide health benefits and be economically efficient. Exclusively treating non-IDUs provided the least health benefit, and was the least economically efficient. Our findings highlight the urgency of initiating HAART for both IDUs and non-IDUs in Russia.

The cost-effectiveness of a modestly effective HIV vaccine in the United States

Background—Treatment options for end-stage heart failure include inotrope-dependent medical therapy, orthotopic heart transplantation (OHT), left ventricular assist device (LVAD) as destination therapy or bridge to transplant. Methods and Results—We developed a state-transition model to simulate 4 treatment options and associated morbidity and mortality. Transition probabilities, costs, and utilities were estimated from published sources. Calculated outcomes included survival, quality-adjusted life-years, and incremental cost-effectiveness. Sensitivity analyses were performed on model parameters to test robustness. Average life expectancy for OHT-eligible patients is estimated at 1.1 years, with 39% surviving to 1 year. OHT with a median wait time of 5.6 months is estimated to increase life expectancy to 8.5 years, and costs <

Expanded HIV Testing in Low-Prevalence, High-Income Countries: A Cost-Effectiveness Analysis for the United Kingdom

100 000/quality-adjusted life-year gained, relative to inotrope-dependent medical therapy. Bridge to transplant-LVAD followed by OHT further is estimated to increase life expectancy to 12.3 years, for