A more aggressive strategy “test and treat” is predicted to reduce AIDS-related mortality, increase the life expectancy of people living with HIV and is cost-effective. However, the cost-effectiveness studies related to “test and treat” strategy did not consider the possibility of increased drug resistance due to poor adherence, which is not rare in developing countries. There is a need for a cost-effectiveness analysis related to “test and treat” strategy in developing countries that includes drug resistance as an important parameter. This analysis is to support the government of Botswana to examine the cost-effectiveness of a HIV/AIDS “test and treat” strategy vs. current treatment guideline, which is providing treatment to patients with a CD4 count of <350 cells/ μL.
Table of Contents
Chapter 1: Introduction: Research background and rationale
Chapter 2: Study objectives
Chapter 3: Study design and methodology
a. Study design
b. Data Source
Chapter 4: Results
Chapter 5: Sensitivity Analysis
Chapter 6: Conclusions and discussion
Research Objectives and Focus
The primary objective of this research is to evaluate the cost-effectiveness of an aggressive "test and treat" HIV/AIDS strategy for the adult population in Botswana, compared to the current treatment guidelines, while specifically incorporating the impact of drug resistance as a critical parameter in the analysis.
- Comparative cost-effectiveness analysis of "test and treat" versus current treatment guidelines.
- Assessment of the impact of HIV/AIDS drug resistance on the effectiveness of treatment strategies.
- Utilization of a Markov model to simulate disease burden and economic outcomes over a 10-year period.
- Determination of the Incremental Cost-Effectiveness Ratio (ICER) to inform government policy decisions.
Excerpt from the Book
Chapter 1: Introduction: Research background and rationale
Acquired immunodeficiency syndrome (AIDS) has killed more than 25 million people since 1981, and about 33 million people (most of them living in low- and middle-income countries) are now infected with human immunodeficiency virus (HIV) [1].
As one of the major treatments against HIV/AIDS, highly active antiretroviral therapy (ART) became available in 1996 but was extremely expensive in developing countries. Lack of ART in developing countries was a problem and was declared as a global health emergency in 2003, since then governments, international agencies, and funding bodies began to implement plans to increase ART coverage in low and mid-income countries. In 2009, more than a third of people who needed ART were receiving it [2].
HIV destroys immune system cells such as CD4 T-cells, leaving infected individuals susceptible to other infections. The CD4 T-cell count (CD4 count) is the major laboratory indicator of immune function in patients who have HIV infection, and it is one of the key factors in determining urgency of ART initiation. For most low and mid-income countries, CD4 count measurements play an important role in determining eligibility for ART [3]. In 2013, World Health Organization released a more aggressive guideline compared to previous guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, which encouraged early treatment for patients with a CD4 cell amount less than 500 cells per cubic millimeter (cells/μL). [3] This is also known as “early treatment”, which defined as therapy initiated when the CD4+ T cell count ranged from 350 to 500 cells/μL.
Summary of Chapters
Chapter 1: Introduction: Research background and rationale: Provides an overview of the global HIV/AIDS epidemic and the evolution of treatment strategies, specifically contrasting early treatment with the more aggressive "test and treat" approach.
Chapter 2: Study objectives: Outlines the primary goal of supporting the Botswana government in assessing the cost-effectiveness of the "test and treat" strategy and investigating the influence of drug resistance.
Chapter 3: Study design and methodology: Describes the use of a Markov model to simulate HIV disease progression and the economic evaluation, including details on the study cohort and data sources.
Chapter 4: Results: Presents the economic findings and health outcomes, concluding that the "test and treat" strategy provides significant quality-adjusted life-year (QALY) gains.
Chapter 5: Sensitivity Analysis: Explores the robustness of the model by varying key parameters to identify the main drivers of the cost-effectiveness ratio.
Chapter 6: Conclusions and discussion: Synthesizes the findings, noting that the strategy is highly cost-effective while acknowledging limitations regarding data availability for drug resistance and incidence rates.
Keywords
HIV/AIDS, Test and treat, Cost-effectiveness, Markov model, Botswana, Drug resistance, Antiretroviral therapy, QALY, Public health, Disease burden, Mortality, Health economics, Sensitivity analysis, Treatment guidelines, HIV transmission.
Frequently Asked Questions
What is the core focus of this research?
The research focuses on analyzing the economic and health-related viability of implementing a "test and treat" HIV strategy in Botswana, which involves offering antiretroviral therapy regardless of the patient's CD4 cell count.
What are the primary themes of the study?
The study centers on cost-effectiveness analysis, the impact of ART, the emergence of drug resistance (MDR), and the assessment of disease outcomes using quality-adjusted life-years.
What is the main objective of the work?
The primary objective is to provide the government of Botswana with evidence-based data regarding the cost-effectiveness of moving from current CD4-based treatment guidelines to a universal "test and treat" approach.
Which scientific methodology is applied?
The study utilizes a multi-state Markov model to simulate the disease progression of a cohort of 10,000 healthy individuals over a 10-year period, comparing two different treatment scenarios.
What topics are discussed in the main body?
The main body covers the research background, specific study objectives, the design of the Markov model, result calculations including ICER, sensitivity analyses, and a detailed discussion on policy implications and study limitations.
Which keywords define this study?
Key terms include HIV/AIDS, "test and treat," cost-effectiveness, Botswana, drug resistance, ART, Markov model, and QALY.
Why is drug resistance included as a parameter?
Drug resistance is included because it is a significant concern in developing nations due to issues with adherence, and the study aims to see if this factor counterbalances the benefits of earlier treatment.
What does the sensitivity analysis reveal?
The sensitivity analysis indicates that while incidence and treatment coverage are the primary drivers of the cost-effectiveness ratio, variables like drug resistance and drug costs have a moderate impact.
How is the health impact measured?
Health impact is measured in Quality-Adjusted Life-Years (QALYs), which allows for a standardized way to compare diverse health consequences of different treatment strategies.
What is the main conclusion for Botswana?
The study concludes that the "test and treat" strategy is very cost-effective for Botswana and should be considered for the adult population, despite the need for further investments in health infrastructure.
- Citation du texte
- Geffrey Li (Auteur), 2015, Cost-effectiveness analysis of HIV/AIDS “Test and treat” strategy vs. Current treatment guideline in Botswana, Munich, GRIN Verlag, https://www.grin.com/document/294007
