PMID- 29131849
DCOM- 20171226
LR  - 20171226
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 12
IP  - 11
DP  - 2017
TI  - Modelling the cost-effectiveness of HIV care shows a clear benefit when
      transmission risk is considered in the calculations - A message for Central and
      Eastern Europe.
PG  - e0186131
LID - 10.1371/journal.pone.0186131 [doi]
AB  - BACKGROUND: HIV epidemic remains a major global health issue. Data from
      cost-effectiveness analyses base on CD4+ count and morbidity in patients with
      symptomatic and asymptomatic HIV infection. The approach adopted in these
      analyses includes many other factors, previously not investigated. Additionally, 
      we evaluate the impact of sexual HIV transmission due to delayed cART on the
      cost-effectiveness of care. METHODS: A lifetime Markov model (1-month cycle) was 
      developed to estimate the cost per quality adjusted life years (QALY) for a 1-
      and 3-year delay in starting cART (as compared to starting immediately at linkage
      to care) lifetime costs, clinical outcomes and cost-effectiveness. Patients were 
      categorized into having asymptomatic HIV, AIDS, Hodgkin's Lymphoma, and non-AIDS 
      defining condition. Mortality rates and utility values were obtained from
      published literature. The number of new infected persons was estimated on the
      basis of sexual orientation, the number of sexual partners per year, the number
      of sex acts per month, frequency of condom use and use of cART. For the input
      Test and Keep in Care (TAK) project cohort data were used. Costs of care, cART
      and potential life-years lost were based on estimated total costs and the
      difference in expected QALY gained between an HIV-positive and an average person 
      in Polish population. Costs were based on real expenditures of the Ministry of
      Health, National Health Fund, available studies and experts' opinion. Costs and
      effects were discounted at rates of 5% and 3.5%, respectively. RESULTS: Input
      data were available for 141 patients form TAK cohort. The estimated number of new
      HIV infections in low, medium and high risk transmission groups were 0.28, 0.61, 
      2.07 with 1 and 0.82, 1.80, 6.11 with a 3-year delay, respectively. This
      reflected QALY loss due to cART delay of 0.52, 1.13, 3.84 and 2.02, 4.43, 15.03
      for a 1- and 3-year delay, respectively. If additional costs of treatment and
      potential life-years lost due to new HIV infections were not taken into account, 
      initiating cART immediately at linkage to care was not cost-saving irrespective
      of cART delay. Otherwise, when additional costs and QALY lost due to new HIV
      infections were included, immediate cART initiation was cost-saving regardless of
      the chosen scenarios. CONCLUSIONS: If new HIV infections are not taken into
      account, then starting cART immediately does not dominate comparing to delaying
      cART. When taking into account HIV transmission in cost-effectiveness analysis,
      immediate initiation of HIV treatment is a profitable decision from the public
      payer's perspective.
FAU - Kowalska, Justyna D
AU  - Kowalska JD
AD  - Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, 
AD  - HIV Out-Patients Clinic, Hospital for Infectious Diseases in Warsaw, Warsaw,
FAU - Wojcik, Grzegorz
AU  - Wojcik G
AD  - HTA Consulting, Cracow, Poland.
FAU - Rutkowski, Jakub
AU  - Rutkowski J
AD  - HTA Consulting, Cracow, Poland.
FAU - Ankiersztejn-Bartczak, Magdalena
AU  - Ankiersztejn-Bartczak M
AD  - Foundation of Social Education (FES), Warsaw, Poland.
FAU - Siewaszewicz, Ewa
AU  - Siewaszewicz E
AD  - Gilead Sciences, Warsaw, Poland.
LA  - eng
PT  - Journal Article
DEP - 20171113
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
RN  - 0 (Anti-HIV Agents)
SB  - IM
MH  - Adult
MH  - Anti-HIV Agents/economics/therapeutic use
MH  - Cohort Studies
MH  - Condoms/utilization
MH  - *Cost-Benefit Analysis
MH  - Europe/epidemiology
MH  - Female
MH  - HIV Infections/drug therapy/*epidemiology/therapy/transmission
MH  - *Health Care Costs
MH  - Humans
MH  - Male
MH  - Markov Chains
MH  - Quality-Adjusted Life Years
MH  - Sexual Partners
PMC - PMC5683634
EDAT- 2017/11/14 06:00
MHDA- 2017/12/27 06:00
CRDT- 2017/11/14 06:00
PHST- 2017/04/29 00:00 [received]
PHST- 2017/09/26 00:00 [accepted]
PHST- 2017/11/14 06:00 [entrez]
PHST- 2017/11/14 06:00 [pubmed]
PHST- 2017/12/27 06:00 [medline]
AID - 10.1371/journal.pone.0186131 [doi]
AID - PONE-D-17-16561 [pii]
PST - epublish
SO  - PLoS One. 2017 Nov 13;12(11):e0186131. doi: 10.1371/journal.pone.0186131.
      eCollection 2017.