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Previous Volume 344:824-831 March 15, 2001 Number 11 Next

	Full Text PDF Editorial by Steinbrook, R. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Combination antiretroviral therapy with a combination of three or more drugs has become the standard of care for patients with human immunodeficiency virus (HIV) infection in the United States. We estimated the clinical benefits and cost effectiveness of three-drug antiretroviral regimens.

Methods We developed a mathematical simulation model of HIV disease, using the CD4 cell count and HIV RNA level as predictors of the progression of disease. Outcome measures included life expectancy, life expectancy adjusted for the quality of life, lifetime direct medical costs, and cost effectiveness in dollars per quality-adjusted year of life gained. Clinical data were derived from major clinical trials, including the AIDS Clinical Trials Group 320 Study. Data on costs were based on the national AIDS Cost and Services Utilization Survey, with drug costs obtained from the Red Book.

Results For patients similar to those in the AIDS Clinical Trials Group 320 Study (mean CD4 cell count, 87 per cubic millimeter), life expectancy adjusted for the quality of life increased from 1.53 to 2.91 years, and per-person lifetime costs increased from $45,460 to $77,300 with three-drug therapy as compared with no therapy. The incremental cost per quality-adjusted year of life gained, as compared with no therapy, was $23,000. On the basis of additional data from other major studies, the cost-effectiveness ratio for three-drug therapy ranged from $13,000 to $23,000 per quality-adjusted year of life gained. The initial CD4 cell count and drug costs were the most important determinants of costs, clinical benefits, and cost effectiveness.

Conclusions Treatment of HIV infection with a combination of three antiretroviral drugs is a cost-effective use of resources.

Source Information

From the Division of General Internal Medicine and the Partners AIDS Research Center, Massachusetts General Hospital and Harvard Medical School, Boston (K.A.F., E.L., H.Z., A.D.K.); the Department of Epidemiology and Biostatistics, Boston University School of Public Health, Boston (K.A.F., E.L., D.E.C.); the Department of Health Policy and Management and the Center for Risk Analysis (K.A.F., M.C.W., S.J.G.) and the Department of Epidemiology (G.R.S.), Harvard School of Public Health, Boston; Community Research Initiative New England, Boston (C.J.C.); the Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, Conn. (A.D.P.); and the Department of Medicine, Boston Medical Center, and Boston University School of Medicine, Boston (D.E.C.).

Address reprint requests to Dr. Freedberg at the Division of General Internal Medicine, Massachusetts General Hospital, 50 Staniford St., 9th Fl., Boston, MA 02114, or at kfreedberg{at}partners.org.

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