A narrative review of cost-effectiveness analysis of people living with HIV treated with HAART: from interventions to outcomes

Abstract

Background

Since its introduction in 1996, highly active antiretroviral therapy (HAART), which involves the combination of antiretroviral drugs, has resulted in significant improvements in the morbidity, mortality, and life expectancy of HIV-infected patients. Numerous studies of the cost-effectiveness of HAART from different perspectives in HIV have been reported.

Aim

To investigate the economic outcomes and relevance of HAART for people living with HIV.

Materials and methods

A narrative literature review was conducted on 22 peer-reviewed full economic evaluations of people living with HIV treated with different HAART regimens and published in English between January 2005 and December 2014. Information regarding study details, such as interventions, outcomes, and modeling methods, was extracted. The high heterogeneity of the included studies rendered a meta-analysis inappropriate; therefore, we conducted a comparative analysis of studies grouped according to the similarity of the different intervention types and outcomes.

Results

Most of the economic evaluations of HAART focused on comparisons between the specific HAART regimens and others from the following perspectives: injecting drug users versus noninjecting drug users, HIV-infected adults without AIDS versus those with AIDS, regimens based on developed world guidelines versus those based on developing world guidelines, self-administered HAART versus directly observed HAART, and “ideal” versus “typical” regimens.

Conclusion

In general, HAART is more cost-effective than other therapeutic regimens adopted so far. Further investigations, especially head-to-head comparisons of “ideal” and “typical” trials of different regimen combinations, are required to identify the optimal HAART regimens.

Keywords:

• narrative review
• cost-effectiveness
• HAART

Acknowledgments

The authors were financially supported by the Project of Philosophy and Social Science Research in Colleges and Universities in Jiangsu Province (2014SJD085).

Author contributions

All authors read and approved the final manuscript. WFT, WY, and WH contributions include selecting studies, collecting data, analyzing and presenting results, and writing and revising the manuscript. WH is responsible for the final content of the paper.

Disclosure

The authors report no conflicts of interest in this work.