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dc.contributor.authorSax, Paul E.en_US
dc.contributor.authorSypek, Alexisen_US
dc.contributor.authorBerkowitz, Bethany K.en_US
dc.contributor.authorMorris, Bethany L.en_US
dc.contributor.authorLosina, Elenaen_US
dc.contributor.authorPaltiel, A. Daviden_US
dc.contributor.authorKelly, Kathleen A.en_US
dc.contributor.authorSeage, George R.en_US
dc.contributor.authorWalensky, Rochelle P.en_US
dc.contributor.authorWeinstein, Milton C.en_US
dc.contributor.authorEron, Josephen_US
dc.contributor.authorFreedberg, Kenneth A.en_US
dc.date.accessioned2014-12-02T21:27:22Z
dc.date.issued2014en_US
dc.identifier.citationSax, P. E., A. Sypek, B. K. Berkowitz, B. L. Morris, E. Losina, A. D. Paltiel, K. A. Kelly, et al. 2014. “HIV Cure Strategies: How Good Must They Be to Improve on Current Antiretroviral Therapy?” PLoS ONE 9 (11): e113031. doi:10.1371/journal.pone.0113031. http://dx.doi.org/10.1371/journal.pone.0113031.en
dc.identifier.issn1932-6203en
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:13454641
dc.description.abstractBackground: We examined efficacy, toxicity, relapse, cost, and quality-of-life thresholds of hypothetical HIV cure interventions that would make them cost-effective compared to life-long antiretroviral therapy (ART). Methods: We used a computer simulation model to assess three HIV cure strategies: Gene Therapy, Chemotherapy, and Stem Cell Transplantation (SCT), each compared to ART. Efficacy and cost parameters were varied widely in sensitivity analysis. Outcomes included quality-adjusted life expectancy, lifetime cost, and cost-effectiveness in dollars/quality-adjusted life year ($/QALY) gained. Strategies were deemed cost-effective with incremental cost-effectiveness ratios <$100,000/QALY. Results: For patients on ART, discounted quality-adjusted life expectancy was 16.4 years and lifetime costs were $591,400. Gene Therapy was cost-effective with efficacy of 10%, relapse rate 0.5%/month, and cost $54,000. Chemotherapy was cost-effective with efficacy of 88%, relapse rate 0.5%/month, and cost $12,400/month for 24 months. At $150,000/procedure, SCT was cost-effective with efficacy of 79% and relapse rate 0.5%/month. Moderate efficacy increases and cost reductions made Gene Therapy cost-saving, but substantial efficacy/cost changes were needed to make Chemotherapy or SCT cost-saving. Conclusions: Depending on efficacy, relapse rate, and cost, cure strategies could be cost-effective compared to current ART and potentially cost-saving. These results may help provide performance targets for developing cure strategies for HIV.en
dc.language.isoen_USen
dc.publisherPublic Library of Scienceen
dc.relation.isversionofdoi:10.1371/journal.pone.0113031en
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232561/pdf/en
dash.licenseLAAen_US
dc.subjectBiology and Life Sciencesen
dc.subjectComputational Biologyen
dc.subjectPopulation Modelingen
dc.subjectInfectious Disease Modelingen
dc.subjectEngineering and Technologyen
dc.subjectManagement Engineeringen
dc.subjectDecision Analysisen
dc.subjectMedicine and health sciencesen
dc.subjectInfectious diseasesen
dc.subjectViral diseasesen
dc.subjectHIV infectionsen
dc.subjectSimulation and Modelingen
dc.subjectMathematical Modelingen
dc.subjectSocial Sciencesen
dc.subjectEconomicsen
dc.subjectEconomic Analysisen
dc.subjectCost-Effectiveness Analysisen
dc.titleHIV Cure Strategies: How Good Must They Be to Improve on Current Antiretroviral Therapy?en
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden
dc.relation.journalPLoS ONEen
dash.depositing.authorSax, Paul E.en_US
dc.date.available2014-12-02T21:27:22Z
dc.identifier.doi10.1371/journal.pone.0113031*
dash.authorsorderedfalse
dash.contributor.affiliatedKelly, Katie
dash.contributor.affiliatedSax, Paul
dash.contributor.affiliatedFreedberg, Kenneth
dash.contributor.affiliatedWalensky, Rochelle
dash.contributor.affiliatedLosina, Elena
dash.contributor.affiliatedSeage, George
dash.contributor.affiliatedWeinstein, Milton


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