Cost-effectiveness of first-line antiretroviral therapy for HIV-infected African children less than 3 years of age
View/ Open
Author
Doherty, Kathleen
Penazzato, Martina
Lindsey, Jane C.
Harrison, Linda
Kelly, Kathleen
Essajee, Shaffiq
Muhe, Lulu
Wools-Kaloustian, Kara
Ayaya, Samuel
Palumbo, Paul
Note: Order does not necessarily reflect citation order of authors.
Published Version
https://doi.org/10.1097/QAD.0000000000000672Metadata
Show full item recordCitation
Ciaranello, A. L., K. Doherty, M. Penazzato, J. C. Lindsey, L. Harrison, K. Kelly, R. P. Walensky, et al. 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. doi:10.1097/QAD.0000000000000672. http://dx.doi.org/10.1097/QAD.0000000000000672.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.Other Sources
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4536981/pdf/Terms of Use
This article is made available under the terms and conditions applicable to Other Posted Material, as set forth at http://nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of-use#LAACitable link to this page
http://nrs.harvard.edu/urn-3:HUL.InstRepos:22856852
Collections
- HMS Scholarly Articles [17917]
- SPH Scholarly Articles [6362]
Contact administrator regarding this item (to report mistakes or request changes)