Date: Sun, 11 Sep 2005 11:11:28 +0530
From: EMPOWER INDIA <ttn_empower@...>
Subject: Starting HAART Early Rather Than Later Appears Cost Effective and May
Increase Quality Survival Time
To: AIDS_ASIA <AIDS_ASIA@yahoogroups.com>,
AIDSAFRICAASIAalternatives@yahoogroups.com,
AIDS-INDIA <AIDS-INDIA@yahoogroups.com>
CC: SAATHI <saathii@...>,
"'Internationaltreatmentpreparedness@Yahoogroups. Com'"
<internationaltreatmentpreparedness@yahoogroups.com>

Starting HAART Early Rather Than Later Appears Cost Effective and May Increase Quality Survival Time

Initiating HAART at a CD4+ T-cell count greater than
350 cells/microliter may be cost-effective compared
with initiating HAART at a CD4+ T-cell count less than
350 cells/microliter but greater than 200
cells/microliter and may result in longer
quality-adjusted survival, according to study results
that appear in the August 15, 2005 issue of the
Journal of Acquired Immune Deficiency Syndromes.


Cohort studies indicate that starting HAART when the
CD4+ T-cell count is less than 200 cells/microliter is
associated with poor outcomes. These studies have been
unable to address how early HAART should be initiated,
however.

This report uses a Markov modeling approach to compare
starting HAART at a mean CD4+ T-cell count greater
than 350 cells/microliter (early) versus less than 350
cells/microliter but greater than 200 cells/microliter
(later).

Results

· Starting HAART earlier rather than later increases
total lifetime costs by $19,074, increases years of
life by 1.21 years, increases discounted
quality-adjusted life-years by 0.61, and has an
incremental cost-effectiveness ratio of $31,266 per
quality-adjusted life-year.

· Early therapy is more cost-effective when the impact
of HAART on well-being is smaller.

The results of this analyses (which uses the Markov
cost-effectiveness model and real-world data from
urban hospitals) demonstrate that starting HAART
earlier (at a CD4+ T-cell count greater than 350
cells/microliter) rather than later (at a CD4+ T-cell
count less than 350 cells/microliter but greater than
200 cells/microliter) increases total lifetime costs,
increases life expectancy, and is a cost-effective
strategy when this is defined as a strategy with a
cost per life-year gained or cost per quality-adjusted
life-year gained less than $50,000, which is a
generally accepted benchmark in the United States.

The results also confirm the generally accepted view
that starting HAART at a CD4+ T-cell count less than
350 cells/ microliter but greater than 200 cells/
microliter is cost-effective compared with starting at
a CD4+ T-cell count less than 200 cells/microliter .
This modeling exercise indicates that further life
expectancy and quality-adjusted life expectancy gains
can be expected when starting HAART at a CD4+ T-cell
count greater than 350/microliter and that this early
treatment strategy is also likely to be
cost-effective.

The results of this study indicate that physicians and
patients making decisions about when to start HAART
should balance the likely benefits on life expectancy
with the possible negative impact on overall
well-being associated with HAART. Clearly, drug
regimens that have more convenient dosing regimens and
fewer adverse effects can minimize the negative impact
on overall well-being and thus would be likely to have
greater value, assuming that their price was similar
to the prices of drugs with less favorable side-effect
profiles.

For the time being, say the study authors, there seems
to be little evidence to suggest that the initiation
of HAART should be delayed on the basis of
cost-effectiveness. This would be especially true if
new drugs that have a more favorable side-effect
profile become available.

RTI Health Solutions, Research Triangle Park, NC;
Center for AIDS and STD Harborview Medical Center,
University of Washington, Seattle, WA; Duke Clinical
Research Institute, Durham, NC; and GlaxoSmithKline,
Research Triangle Park, NC.

08/26/05

Reference
J Mauskopf and others. HIV Antiretroviral Treatment:
Early Versus Later. Journal of Acquired Immune
Deficiency Syndromes 39(5): 562-569. August 15, 2005.
 

Cross posted: mtaagplus

Forwarded by :

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