Results: 4

1.
Figure 4

Figure 4. From: When to Start Antiretroviral Therapy in Resource-limited Settings.

Model-generated survival curves for ART starting at <350/μl, <250/μl, or no ART (co-trimoxazole alone). The annual mortality hazard two years after entry into care was 0.01 for ART at <350/μl, 0.05 for ART at CD4 <250/μl, and 0.06 with no ART. Two years after entry into care, the composite annual hazard of severe opportunistic disease, tuberculosis, or death was 0.06 for ART at <350/μl, 0.16 for ART at CD4 <250/μl, and 0.17 with no ART (data not shown).

Rochelle P. Walensky, et al. Ann Intern Med. ;151(3):157-166.
2.
Figure 2

Figure 2. From: When to Start Antiretroviral Therapy in Resource-limited Settings.

Model-based projections over the next five years, under an ART at <350/μl (in white) and an ART at <250/μl (in black) initiation strategy. Total deaths are indicated by squares and total opportunistic diseases by diamonds for the two strategies (left vertical axis). The excess total costs of ART at <350/μl compared to ART at <250/μl over a 5-year horizon are indicated by bars (right vertical axis). The x-axis represents results at varying proportions of HIV cases identified and linked to care in the population. (OD: opportunistic disease)

Rochelle P. Walensky, et al. Ann Intern Med. ;151(3):157-166.
3.
Figure 3

Figure 3. From: When to Start Antiretroviral Therapy in Resource-limited Settings.

The incremental cost-effectiveness of ART at <350/μl vs. ART at <250/μl at alternative values of “p”, the probability that the trial will confirm model-based results indicating a benefit for earlier therapy (see Methods and Figure 1). The incremental cost-effectiveness is provided for the 5-year time horizon and reported in dollars per year of life saved. (YLS: years of life saved, GDP: per capita gross domestic product in South Africa (US$5,400)). The height of the bar provides the cost-effectiveness ratio of ART at <350/μl vs. ART at <250/μl for alternative values of p; bars that remain below the horizontal dashed line (<3× GDP) are considered to be “cost-effective” and those that remain below the horizontal dotted-dashed line (<1× GDP) are considred to be “very cost-effective.”

Rochelle P. Walensky, et al. Ann Intern Med. ;151(3):157-166.
4.
Figure 1

Figure 1. From: When to Start Antiretroviral Therapy in Resource-limited Settings.

Decision tree outlining the ART strategy options over the next five years while awaiting “when to start” trial results. The payoffs in terms of both clinical outcomes and costs are delineated to the right of the tree. The probability, “p”, represents the chance that the trial will demonstrate a clinical benefit to ART at <350/μl. Using a cost-effectiveness willingness-to-pay threshold of 3 × the per capita GDP in South Africa ($16,200/YLS), the tree suggests an optimal policy of ART at <350/μl now for values of p such that:

As described in the Results section, values of p ≥ 0.17 satisfy this decision rule.

Rochelle P. Walensky, et al. Ann Intern Med. ;151(3):157-166.

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