Widespread HIV screening and access to highly active
antiretroviral treatment (ART) were cost effective in mathematical models, but
population-level implementation has led to questions about cost, value, and
feasibility. In 1996, British Columbia, Canada, introduced universal coverage
of drug and other health-care costs for people with HIV/AIDS and and began
extensive scale-up in access to ART. We aimed to assess the cost-effectiveness
of ART scale-up in British Columbia compared with hypothetical scenarios of
constrained treatment access.
Using comprehensive linked population-level data, we
populated a dynamic, compartmental transmission model to simulate the HIV/AIDS
epidemic in British Columbia from 1997 to 2010. We estimated HIV incidence,
prevalence, mortality, costs (in 2010 CAN$), and quality-adjusted life-years
(QALYs) for the study period, which was 1997-2010. We calculated incremental
cost-effectiveness ratios from societal and third-party-payer perspectives to
compare actual practice (true numbers of individuals accessing ART) to scenarios
of constrained expansion (75% and 50% probability of accessing ART). We also
investigated structural and parameter uncertainty.
Actual practice resulted in 263 averted incident cases
compared with 75% of observed access and 676 averted cases compared with 50% of
observed access to ART. From a third-party-payer perspective, actual practice
resulted in incremental cost-effectiveness ratios of $23 679 per QALY versus
75% access and $24 250 per QALY versus 50% access. From a societal perspective,
actual practice was cost saving within the study period. When the model was
extended to 2035, current observed access resulted in cumulative savings of
$25·1 million compared with the 75% access scenario and $65·5 million compared
with the 50% access scenario.
ART scale-up in British Columbia has decreased HIV-related
morbidity, mortality, and transmission. Resulting incremental cost-effectiveness
ratios for actual practice, derived within a limited timeframe, were within
established cost-effectiveness thresholds and were cost saving from a societal
perspective.
Via: http://goo.gl/tdBvFW Purchase
full article at:
By:
- 1BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada.
- 2BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
- 3Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
- 4BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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