PLoS ONE (Jan 2011)

The cost-effectiveness of early access to HIV services and starting cART in the UK 1996-2008.

  • Eduard J Beck,
  • Sundhiya Mandalia,
  • Roshni Sangha,
  • Peter Sharott,
  • Mike Youle,
  • Guy Baily,
  • Ray Brettle,
  • Mark Gompels,
  • Margaret Johnson,
  • Brendan McCarron,
  • Ed Ong,
  • Anton Pozniak,
  • Achim Schwenk,
  • Stephen Taylor,
  • John Walsh,
  • Ed Wilkins,
  • Ian Williams,
  • Brian Gazzard,
  • NPMS-HHC Steering Group

DOI
https://doi.org/10.1371/journal.pone.0027830
Journal volume & issue
Vol. 6, no. 12
p. e27830

Abstract

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To calculate use, cost and cost-effectiveness of people living with HIV (PLHIV) starting routine treatment and care before starting combination antiretroviral therapy (cART) and PLHIV starting first-line 2NRTIs+NNRTI or 2NRTIs+PI(boosted), comparing PLHIV with CD4≤200 cells/mm3 and CD4>200 cells/mm3. Few studies have calculated the use, cost and cost-effectiveness of routine treatment and care before starting cART and starting cART above and below CD4 200 cells/mm3.Use, costs and cost-effectiveness were calculated for PLHIV in routine pre-cART and starting first-line cART, comparing CD4≤200 cells/mm3 with CD4>200 cells/mm3 (2008 UK prices).cART naïve patients CD4≤200 cells/mm3 had an annual cost of £6,407 (95%CI £6,382 to £6,425) PPY compared with £2,758 (95%CI £2,752 to £2,761) PPY for those with CD4>200 cells/mm3; cost per life year gained of pre-cART treatment and care for those with CD4>200 cells/mm3 was £1,776 (cost-saving to £2,752). Annual cost for starting 2NRTIs+NNRTI or 2NRTIs+PI(boosted) with CD4≤200 cells/mm3 was £12,812 (95%CI £12,685-£12,937) compared with £10,478 (95%CI £10,376-£10,581) for PLHIV with CD4>200 cells/mm3. Cost per additional life-year gained on first-line therapy for those with CD4>200 cells/mm3 was £4639 (£3,967 to £2,960).PLHIV starting to use HIV services before CD4≤200 cells/mm3 is cost-effective and enables them to be monitored so they start cART with a CD4>200 cells/mm3, which results in better outcomes and is cost-effective. However, 25% of PLHIV accessing services continue to present with CD4≤200 cells/mm3. This highlights the need to investigate the cost-effectiveness of testing and early treatment programs for key populations in the UK.