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Economic Evaluation of ART

Economic Evaluation of ART - Economic evaluation of ART in...

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Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Economic evaluation of ART in resource-limited countries Sandrine Loubiere a , Constance Meiners a,b,c , Caroline Sloan d , Kenneth A. Freedberg d and Yazdan Yazdanpanah e,f Introduction The present decade has witnessed an unprecedented mobilization of resources and engagement of governments and international and nongovernmental organizations for the expansion of access to antiretroviral therapy (ART) for HIV-infected people in low- and middle-income settings [1]. Combination ART has become the standard of HIV care around the world and produces comparable clinical results in both developed and developing countries [2–5]. Despite the dramatic rise in global funding for HIV/AIDS and reductions in drug prices [6], many resource-limited countries will have difficulty sustaining long-term therapy due to logistical and political barriers and, more impor- tantly, substantial resource constraints. Among patients who are able to initiate ART and reach treatment goals, one main concern is the frequency with which costly laboratory tests should be administered to monitor treatment efficacy and toxicity, as well as the choice of subsequent therapeutic regimens, in which most drugs are still patented and thus very costly compared with first-line regimens [7]. This situation suggests a growing trade-off between program coverage and treatment quality objectives in many resource-limited settings. In the face of economic constraints, it is critically import- ant to evaluate how best to utilize available resources [8,9]. Cost–effectiveness analysis (CEA) is a well estab- lished methodology for understanding, prioritizing and optimizing healthcare services. By comparing treatment alternatives in light of their relative advantages and costs, CEA can serve as one key element to inform HIV/AIDS treatment guidelines [10]. In this article, we review the growing number of CEAs of HIV treatment in resource-limited settings that use either cohort studies or mathematical models. Several studies conducted in resource-limited settings have already shown that a single line of ART is cost effective and very cost effective in certain settings compared with no ART [10–13,14 ±± ,15 ±± ]. We focus on studies that a INSERM/IRD/University of the Mediterranean - UMR 912 ‘Economics & Social Sciences, Health Systems & Societies’ and Southeastern Health Regional Observatory (ORS-PACA), Marseille, France, b Institute of Economics, Federal University of Rio de Janeiro (IE/ UFRJ), c Ministry of Planning, Budget, and Administration, Brasilia, Brazil, d Divisions of General Medicine and Infectious Diseases and the Harvard Center for AIDS Research, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA, e Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, Faculte ´ de Me ´decine de Lille and f EA2694, Faculte ´ de Me ´decine, Lille, France
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