Cost-effectiveness of first-line antiretroviral therapy for HIV-infected African children less than 3 years of age
dc.contributor.author | Ciaranello, Andrea L. | |
dc.contributor.author | Doherty, Kathleen | |
dc.contributor.author | Penazzato, Martina | |
dc.contributor.author | Lindsey, Jane C. | |
dc.contributor.author | Harrison, Linda | |
dc.contributor.author | Kelly, Kathleen | |
dc.contributor.author | Walensky, Rochelle P. | |
dc.contributor.author | Essajee, Shaffiq | |
dc.contributor.author | Losina, Elena | |
dc.contributor.author | Muhe, Lulu | |
dc.contributor.author | Wools-Kaloustian, Kara | |
dc.contributor.author | Ayaya, Samuel | |
dc.contributor.author | Weinstein, Milton C. | |
dc.contributor.author | Palumbo, Paul | |
dc.contributor.author | Freedberg, Kenneth A. | |
dc.contributor.department | Department of Medicine, IU School of Medicine | en_US |
dc.date.accessioned | 2016-03-31T17:14:22Z | |
dc.date.available | 2016-03-31T17:14:22Z | |
dc.date.issued | 2015-06-19 | |
dc.description.abstract | BACKGROUND: The International Maternal, Pediatric, and Adolescent Clinical Trials P1060 trial demonstrated superior outcomes for HIV-infected children less than 3 years old initiating antiretroviral therapy (ART) with lopinavir/ritonavir compared to nevirapine, but lopinavir/ritonavir is four-fold costlier. DESIGN/METHODS: We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-Pediatric model, with published and P1060 data, to project outcomes under three strategies: no ART; first-line nevirapine (with second-line lopinavir/ritonavir); and first-line lopinavir/ritonavir (second-line nevirapine). The base-case examined South African children initiating ART at age 12 months; sensitivity analyses varied all key model parameters. Outcomes included life expectancy, lifetime costs, and incremental cost-effectiveness ratios [ICERs; dollars/year of life saved ($/YLS)]. We considered interventions with ICERs less than 1× per-capita gross domestic product (South Africa: $7500)/YLS as 'very cost-effective,' interventions with ICERs below 3× gross domestic product/YLS as 'cost-effective,' and interventions leading to longer life expectancy and lower lifetime costs as 'cost-saving'. RESULTS: Projected life expectancy was 2.8 years with no ART. Both ART regimens markedly improved life expectancy and were very cost-effective, compared to no ART. First-line lopinavir/ritonavir led to longer life expectancy (28.8 years) and lower lifetime costs ($41 350/person, from lower second-line costs) than first-line nevirapine (27.6 years, $44 030). First-line lopinavir/ritonavir remained cost-saving or very cost-effective compared to first-line nevirapine unless: liquid lopinavir/ritonavir led to two-fold higher virologic failure rates or 15-fold greater costs than in the base-case, or second-line ART following first-line lopinavir/ritonavir was very ineffective. CONCLUSIONS: On the basis of P1060 data, first-line lopinavir/ritonavir leads to longer life expectancy and is cost-saving or very cost-effective compared to first-line nevirapine. This supports WHO guidelines, but increasing access to pediatric ART is critical regardless of the regimen used. | en_US |
dc.eprint.version | Final published version | en_US |
dc.identifier.citation | Ciaranello, A. L., Doherty, K., Penazzato, M., Lindsey, J. C., Harrison, L., Kelly, K., … Freedberg, K. A. (2015). Cost-effectiveness of first-line antiretroviral therapy for HIV-infected African children less than 3 years of age. AIDS (London, England), 29(10), 1247–1259. http://doi.org/10.1097/QAD.0000000000000672 | en_US |
dc.identifier.issn | 1473-5571 | en_US |
dc.identifier.uri | https://hdl.handle.net/1805/9156 | |
dc.language.iso | en_US | en_US |
dc.publisher | Ovid Technologies (Wolters Kluwer) - Lippincott Williams & Wilkins | en_US |
dc.relation.isversionof | 10.1097/QAD.0000000000000672 | en_US |
dc.relation.journal | AIDS (London, England) | en_US |
dc.rights | Attribution-NonCommercial-NoDerivatives 4.0 International | |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0 | |
dc.source | PMC | en_US |
dc.subject | Anti-Retroviral Agents | en_US |
dc.subject | economics | en_US |
dc.subject | therapeutic use | en_US |
dc.subject | Antiretroviral Therapy, Highly Active | en_US |
dc.subject | methods | en_US |
dc.subject | HIV Infections | en_US |
dc.subject | drug therapy | en_US |
dc.title | Cost-effectiveness of first-line antiretroviral therapy for HIV-infected African children less than 3 years of age | en_US |
dc.type | Article | en_US |
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