George R. Seage

The Cost Effectiveness of Combination Antiretroviral Therapy for HIV Disease

BACKGROUND Combination antiretroviral therapy with a combination of three or more drugs has become the standard of care for patients with human immunodeficiency virus (HIV) infection in the United States. We estimated the clinical benefits and cost effectiveness of three-drug antiretroviral regimens. METHODS We developed a mathematical simulation model of HIV disease, using the CD4 cell count and HIV RNA level as predictors of the progression of disease. Outcome measures included life expectancy, life expectancy adjusted for the quality of life, lifetime direct medical costs, and cost effectiveness in dollars per quality-adjusted year of life gained. Clinical data were derived from major clinical trials, including the AIDS Clinical Trials Group 320 Study. Data on costs were based on the national AIDS Cost and Services Utilization Survey, with drug costs obtained from the Red Book. RESULTS For patients similar to those in the AIDS Clinical Trials Group 320 Study (mean CD4 cell count, 87 per cubic millimeter), life expectancy adjusted for the quality of life increased from 1.53 to 2.91 years, and per-person lifetime costs increased from

The lifetime cost of current human immunodeficiency virus care in the United States.

45,460 to

DURATION OF HUMAN IMMUNODEFICIENCY VIRUS INFECTION BEFORE DETECTION OF ANTIBODY

77,300 with three-drug therapy as compared with no therapy. The incremental cost per quality-adjusted year of life gained, as compared with no therapy, was

Sexual risk, nitrite inhalant use, and lack of circumcision associated with HIV seroconversion in men who have sex with men in the united states

23,000. On the basis of additional data from other major studies, the cost-effectiveness ratio for three-drug therapy ranged from

HIV Preexposure Prophylaxis in the United States: Impact on Lifetime Infection Risk, Clinical Outcomes, and Cost-Effectiveness

13,000 to

Expanded HIV Screening in the United States: Effect on Clinical Outcomes, HIV Transmission, and Costs

23,000 per quality-adjusted year of life gained. The initial CD4 cell count and drug costs were the most important determinants of costs, clinical benefits, and cost effectiveness. CONCLUSIONS Treatment of HIV infection with a combination of three antiretroviral drugs is a cost-effective use of resources.

INFECTIOUSNESS OF HIV BETWEEN MALE HOMOSEXUAL PARTNERS

Objective:We sought to project the lifetime cost of medical care for human immunodefiency virus (HIV)-infected adults using current antiretroviral therapy (ART) standards. Methods:Medical visits and hospitalizations for any reason were from the HIV Research Network, a consortium of high-volume HIV primary care sites. HIV treatment drug regimen efficacies were from clinical guidelines and published sources; data on other drugs used were not available. In a computer simulation model, we projected HIV medical care costs in 2004 U.S. dollars. Results:From the time of entering HIV care, per person projected life expectancy is 24.2 years, discounted lifetime cost is

Long-Term Effectiveness of Highly Active Antiretroviral Therapy on the Survival of Children and Adolescents with HIV Infection: A 10-Year Follow-Up Study

385,200, and undiscounted cost is

Meta-Analysis: Increased Mortality Associated with Hepatitis C in HIV-Infected Persons Is Unrelated to HIV Disease Progression

618,900 for adults who initiate ART with CD4 cell count <350/&mgr;L. Seventy-three percent of the cost is antiretroviral medications, 13% inpatient care, 9% outpatient care, and 5% other HIV-related medications and laboratory costs. For patients who initiate ART with CD4 cell count <200/&mgr;L, projected life expectancy is 22.5 years, discounted lifetime cost is

Readiness of high-risk populations in the HIV network for prevention trials to participate in HIV vaccine efficacy trials in the United States

354,100 and undiscounted cost is