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

Figures & data

Figure 1 Summary of study-search and selection process.

Table 1 Study characteristics

Reference	Region	Perspective	Population	Modeling	Timescale	Discount
Moeremans et al^Citation5	Belgium, Italy, Sweden, UK	Reimbursement authorities	HIV-infected adults	Markov model	Lifetime	Based on local guidelines
Long et al^Citation6	St Petersburg, Russia	NA	IDUs and non-IDUs	Dynamic HIV-epidemic model	20 years	3%
Vijayaraghavan et al^Citation7	South Africa	NA	HIV-positive adults	Markov model	Lifetime	NA
Hubben et al^Citation8	The Netherlands	Dutch health care	HIV-infected patients	Markov model	Lifetime	4%, 1.5%
Johnston et al^Citation9	British Columbia, Canada	Payers	Asymptomatic HIV patients	Mathematical model	30 years	NA
Binagwaho et al^Citation10	Rwanda	Health care payers	Pregnant women	NA	Lifetime	3%
Orlando et al^Citation11	Malawi	Private, public	Pregnant women	NA	NA	15%
Brogan et al^Citation12	USA	Societal	HIV-infected adults	Markov model	Lifetime	3%
Simpson et al^Citation13	USA	Payers	Treatment-experienced HIV Patients	Markov model	Lifetime	3%
Badri et al^Citation14	South Africa	Public healthcare system	HIV-infected adults without AIDS and with AIDS	NA	NA	NA
Marseille et al^Citation15	Rural Uganda	Societal	HIV-infected patients	NA	15 years	3%
Rizzardini et al^Citation16	Italy	Lombardy Regional Health Service	Adult HIV subjects who received HAART therapy for the first time	Markov model	2 years	None
Colombo et al^Citation17	Italy	Italian National Health Service	HIV-infected patients	Markov model	10 years	3.50%
McCabe et al^Citation18	NA	Societal	HIV-infected pregnant women	Mathematical model	Lifetime	3%
Munakata et al^Citation19	NA	Societal	HIV patients on an initial regimen of HAART	Markov model	Lifetime	3%
Colombo et al^Citation20	Italy	Italian health care system	HIV-infected patients	Markov model	10 years	3.50%
Granich et al^Citation21	South Africa	NA	HIV-infected patients	Epidemic model	40 years	3%
Fang et al^Citation22	Taiwan	National health insurance	HIV-positive patients and AIDS	NA	NA	NA
Ono et al^Citation23	Thailand	NA	HIV-infected patients	Markov model	NA	3%
Badri et al^Citation24	Sub-Saharan Africa	Public health	HIV-infected patients	Markov model	Lifetime	8%
Mauskopf et al^Citation25	NA	NA	HIV-infected patients	Markov model	25 years	3%
Mauskopf et al^Citation26	USA	NA	Treatment-experienced patients	Markov model	5 years, lifetime	3%

Abbreviations: NA, not applicable; IDUs, injecting drug users; HAART, highly active antiretroviral therapy.

Table 2 Study characteristics of outcomes

Reference	Interventions	QALYs/DALYs	LYG	NB	ICER	Sensitivity analyses
Moeremans et al^Citation5	DRV/r versus LPV/r	QALYs 0.785 in Belgium, 0.608 in Italy, 0.584 in Sweden, 0.550 in the UK	NA	NA	€6,964/QALY gained in Belgium, €9,277/QALY gained in Italy, €6,868/QALY gained in Sweden, €14,778/QALY gained in the UK	PSA
Long et al^Citation6	HAART treating HIV-infected IDUs versus non-IDUs	NA	NA	NA	$1,501/QALY gained if treat IDUs, $2,572/QALY gained if treat non-IDUs, $1,827/QALY gained if treat untargeted	One-way, two-way
Vijayaraghavan et al^Citation7	HAART (developed-world guidelines versus developing-world guidelines)	3.00 QALYs	NA	$39.4 billion	$3,956 per QALY gained	One-way, multiway
Hubben et al^Citation8	TPV/r versus CPI/r	0.51 QALYs gained	0.52	NA	€42,500 per QALY gained	One-way
Johnston et al^Citation9	HAART expansion versus no HAART	NA	NA	$900 million	NA	PSA
Binagwaho et al^Citation10	Dual ARV prophylaxis with either 12 months breastfeeding or replacement feeding; short-course (Sc)-HAART prophylaxis with either 6 months’ breastfeeding, 12 months’ breastfeeding, or 18 months’ breastfeeding; Sc-HAART prophylaxis with replacement feeding	NA	NA	Highest net costs with Sc-HAART with 6 months’ breastfeeding ($213,912,837); lowest net costs with Sc-HAART and 18 months’ breastfeeding ($210,410,727)	Sc-HAART with 12 months’ breastfeeding allowing for more children to be alive and HIV-uninfected by 18 months than Sc-HAART with 6 months’ breastfeeding, for an incremental cost per child alive and uninfected of $11,882	One-way
Orlando et al^Citation11	HAART versus no intervention	DALYs: 10,449 saved	NA	$998 per person, $–261 by public	NA	One-way
Brogan et al^Citation12	DRV/r versus LPV/r	QALYs: 0.493	NA	NA	$23,057 per QALY gained	PSA
Simpson et al^Citation13	TPV/r versus CPI/r	QALYs: 0.64	NA	NA	$56,517 per QALY gained	PSA
Badri et al^Citation14	HIV-infected adults without AIDS versus with AIDS	NA	NA	NA	$1,622 per LYG without AIDS, $675 per LYG with AIDS	One-way
Marseille et al^Citation15	HAART and cotrimoxazole prophylaxis versus cotrimoxazole	DALYs: 6,861 saved	NA	$4.09 million	NA	One-way, multiway
Rizzardini et al^Citation16	TDF FTC: EFV versus TDF FTC, ATZ RTV versus TDF FTC, LPV/r RTV versus AZT 3TC LPV/r RTV	NA	NA	NA	TDF + FTC + EFV €34,965, remaining strategies ranged from €53,000 to €62,000 per QALY (compared with untreated)	One-way
Colombo et al^Citation17	TDF/FTC + RPV (STR), TDF/FTC + RPV, TDF/FTC + EFV, TDF/FTC + ATV/r, TDF/FTC + DRV/r, TDF/FTC + RAL, ABC/3TC + EFV, ABC/3TC + ATV/r	NA	NA	NA	STR the most cost-effective choice (€13,655.00), followed by TDF/FTC + RPV (€15,803.00) and TDF/FTC + EFV (€16,181.00) (compared with untreated)	One-way
McCabe et al^Citation18	Self-administered HAART versus directly observed HAART versus No HAART	NA	NA	$14,233	NA	Univariate, bivariate
Munakata et al^Citation19	“Ideal” (based on clinical trials) and “typical” (based on observational studies in actual practice)	QALYs: 1.2	NA	NA	$29,400/QALY gained	One-way, two-way
Colombo et al^Citation20	TDF/FTC + EFV; (STR) TDF/FTC + EFV; TDF/FTC + ATV/r; TDF/FTC + NVP; TDF/FTC + DRV/r; TDF/FTC + LPV/r; TDF/FTC + RAL; TDF + 3TC + EFV; ABC/3TC + EFV; ABC/3TC + ATV/r; ABC/3TC + LPV/r	NA	NA	NA	TDF/FTC + EFV (STR) €22,017, TDF/FTC + EFV €24,526, TDF/FTC + NVP €26,416, TDF/FTC + EFV €26,558 (compared with untreated)	One-way
Granich et al^Citation21	HAART to CD4 <200, CD4 <350, CD4 <500, all CD4	Expanding ART to CD4 count <350 cells/mm^3 reduced DALYs by 14% from 109 to 93 million over 40 years	NA	Costs drop $504 million over 5 years and $3.9 billion over 40 years	NA	Univariate, bivariate
Fang et al^Citation22	Pre-HAART era versus HAART era	NA	AIDS group $5,189, non-AIDS group $6,652	NA	AIDS group $7,109/QALY gained, non-AIDS group, $9,782/QALY gained	One-way
Ono et al^Citation23	HAART versus vaccine versus combined	NA	NA	NA	HAART versus vaccine versus combined $75, $610, $267 per DALY compared with no treatment	One-way
Badri et al^Citation24	HAART to CD4 <200, CD4 <350, CD4 >350, no HAART	NA	NA	NA	Therapy at <200 $54 per QALY versus no ART; at 200–350 had an ICER of $616 versus therapy initiation at <200; therapy initiation >350 had an ICER of $1,137 versus therapy initiation at 200–350	One-way
Mauskopf et al^Citation25	HAART to CD4 >350, 200< CD4 <350	QALYs 0.61	1.21	NA	$31,266 per QALY gained	One-way
Mauskopf et al^Citation26	DRV/r versus control PIs	5 years: 0.2 QALYs; lifetime: 1.27 QALYs	NA	NA	$30,046 per QALY gained	One-way and PSA

Abbreviations: QALYs, quality-adjusted life-years; DALYs, disability-adjusted life-years; LYG, life-years gained; NB, net benefit; ICER, incremental cost-effectiveness ratio; NA, not applicable; DRV/r, darunavir boosted with low-dose ritonavir; LPV/r, lopinavir + ritonavir; PSA, probabilistic sensitivity analysis; HAART, highly active antiretroviral therapy; IDUs, injecting drug users; TPV/r, ritonavir-boosted tipranavir; CPI/r, ritonavir-boosted comparator protease inhibitor; ARV, antiretroviral; TDF, tenofovir disoproxil fumarate; FTC, emtricitabine; EFV, efavirenz; ATZ, atazanavir; RTV, ritonavir; AZT, zidovudine; 3TC, lamivudine; STR, single tablet regimen; RAL, raltegravir.

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