The cost-effectiveness of early access to HIV services and starting cART in the UK 1996-2008

Eduard J. Beck; Sundhiya Mandalia; Roshni Sangha; Peter Sharott; Mike Youle; Guy Baily; Ray Brettle; Mark Gompels; Margaret Johnson; Brendan McCarron; Ed Ong; Anton Pozniak; Achim Schwenk; Stephen Taylor; John Walsh; Ed Wilkins; Ian Williams; Brian Gazzard

doi:10.1371/journal.pone.0027830

The cost-effectiveness of early access to HIV services and starting cART in the UK 1996-2008

Eduard J. Beck, Sundhiya Mandalia, Roshni Sangha, Peter Sharott, Mike Youle, Guy Baily, Ray Brettle, Mark Gompels, Margaret Johnson, Brendan McCarron, Ed Ong, Anton Pozniak, Achim Schwenk, Stephen Taylor, John Walsh, Ed Wilkins, Ian Williams, Brian Gazzard

Research output: Contribution to journal › Article › peer-review

37 Citations (Scopus)

Abstract

Aim: To calculate use, cost and cost-effectiveness of people living with HIV (PLHIV) starting routine treatment and care before starting combination antiretroviral therapy (cART) and PLHIV starting first-line 2NRTIs+NNRTI or 2NRTIs+PI _boosted, comparing PLHIV with CD4≤200 cells/mm3 and CD4>200 cells/mm3. Few studies have calculated the use, cost and costeffectiveness of routine treatment and care before starting cART and starting cART above and below CD4 200 cells/mm3. Methods: Use, costs and cost-effectiveness were calculated for PLHIV in routine pre-cART and starting first-line cART, comparing CD4≤200 cells/mm3 with CD4>200 cells/mm3 (2008 UK prices). Results: cART naïve patients CD4≤200 cells/mm3 had an annual cost of £6,407 (95%CI £6,382 to £6,425) PPY compared with £2,758 (95%CI £2,752 to £2,761) PPY for those with CD4>200 cells/mm3; cost per life year gained of pre-cART treatment and care for those with CD4>200 cells/mm3 was £1,776 (cost-saving to £2,752). Annual cost for starting 2NRTIs+NNRTI or 2NRTIs+PI _boosted with CD4≤200 cells/mm3 was £12,812 (95%CI £12,685-£12,937) compared with £10,478 (95%CI £10,376-£10,581) for PLHIV with CD4>200 cells/mm3. Cost per additional life-year gained on first-line therapy for those with CD4>200 cells/mm3 was £4639 (£3,967 to £2,960). Conclusion: PLHIV starting to use HIV services before CD4≤200 cells/mm3 is cost-effective and enables them to be monitored so they start cART with a CD4>200 cells/mm3, which results in better outcomes and is cost-effective. However, 25% of PLHIV accessing services continue to present with CD4≤200 cells/mm3. This highlights the need to investigate the cost-effectiveness of testing and early treatment programs for key populations in the UK.

Original language	English
Article number	e27830
Journal	PLoS ONE
Volume	6
Issue number	12
DOIs	https://doi.org/10.1371/journal.pone.0027830
Publication status	Published - 14 Dec 2011
Externally published	Yes

Bibliographical note

Funding Information:
The NPMS-HHC was financially supported through a non-restrictive grant from Bristol-Myers Squibb. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

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Cite this

Beck, E. J., Mandalia, S., Sangha, R., Sharott, P., Youle, M., Baily, G., Brettle, R., Gompels, M., Johnson, M., McCarron, B., Ong, E., Pozniak, A., Schwenk, A., Taylor, S., Walsh, J., Wilkins, E., Williams, I., & Gazzard, B. (2011). The cost-effectiveness of early access to HIV services and starting cART in the UK 1996-2008. PLoS ONE, 6(12), Article e27830. https://doi.org/10.1371/journal.pone.0027830

@article{727612c640874f7da0df343d345c8bba,

title = "The cost-effectiveness of early access to HIV services and starting cART in the UK 1996-2008",

abstract = "Aim: To calculate use, cost and cost-effectiveness of people living with HIV (PLHIV) starting routine treatment and care before starting combination antiretroviral therapy (cART) and PLHIV starting first-line 2NRTIs+NNRTI or 2NRTIs+PI boosted, comparing PLHIV with CD4≤200 cells/mm3 and CD4>200 cells/mm3. Few studies have calculated the use, cost and costeffectiveness of routine treatment and care before starting cART and starting cART above and below CD4 200 cells/mm3. Methods: Use, costs and cost-effectiveness were calculated for PLHIV in routine pre-cART and starting first-line cART, comparing CD4≤200 cells/mm3 with CD4>200 cells/mm3 (2008 UK prices). Results: cART na{\"i}ve patients CD4≤200 cells/mm3 had an annual cost of £6,407 (95%CI £6,382 to £6,425) PPY compared with £2,758 (95%CI £2,752 to £2,761) PPY for those with CD4>200 cells/mm3; cost per life year gained of pre-cART treatment and care for those with CD4>200 cells/mm3 was £1,776 (cost-saving to £2,752). Annual cost for starting 2NRTIs+NNRTI or 2NRTIs+PI boosted with CD4≤200 cells/mm3 was £12,812 (95%CI £12,685-£12,937) compared with £10,478 (95%CI £10,376-£10,581) for PLHIV with CD4>200 cells/mm3. Cost per additional life-year gained on first-line therapy for those with CD4>200 cells/mm3 was £4639 (£3,967 to £2,960). Conclusion: PLHIV starting to use HIV services before CD4≤200 cells/mm3 is cost-effective and enables them to be monitored so they start cART with a CD4>200 cells/mm3, which results in better outcomes and is cost-effective. However, 25% of PLHIV accessing services continue to present with CD4≤200 cells/mm3. This highlights the need to investigate the cost-effectiveness of testing and early treatment programs for key populations in the UK.",

author = "Beck, {Eduard J.} and Sundhiya Mandalia and Roshni Sangha and Peter Sharott and Mike Youle and Guy Baily and Ray Brettle and Mark Gompels and Margaret Johnson and Brendan McCarron and Ed Ong and Anton Pozniak and Achim Schwenk and Stephen Taylor and John Walsh and Ed Wilkins and Ian Williams and Brian Gazzard",

note = "Funding Information: The NPMS-HHC was financially supported through a non-restrictive grant from Bristol-Myers Squibb. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials. ",

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month = dec,

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doi = "10.1371/journal.pone.0027830",

language = "English",

volume = "6",

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Beck, EJ, Mandalia, S, Sangha, R, Sharott, P, Youle, M, Baily, G, Brettle, R, Gompels, M, Johnson, M, McCarron, B, Ong, E, Pozniak, A, Schwenk, A, Taylor, S, Walsh, J, Wilkins, E, Williams, I & Gazzard, B 2011, 'The cost-effectiveness of early access to HIV services and starting cART in the UK 1996-2008', PLoS ONE, vol. 6, no. 12, e27830. https://doi.org/10.1371/journal.pone.0027830

TY - JOUR

T1 - The cost-effectiveness of early access to HIV services and starting cART in the UK 1996-2008

AU - Beck, Eduard J.

AU - Mandalia, Sundhiya

AU - Sangha, Roshni

AU - Sharott, Peter

AU - Youle, Mike

AU - Baily, Guy

AU - Brettle, Ray

AU - Gompels, Mark

AU - Johnson, Margaret

AU - McCarron, Brendan

AU - Ong, Ed

AU - Pozniak, Anton

AU - Schwenk, Achim

AU - Taylor, Stephen

AU - Walsh, John

AU - Wilkins, Ed

AU - Williams, Ian

AU - Gazzard, Brian

N1 - Funding Information: The NPMS-HHC was financially supported through a non-restrictive grant from Bristol-Myers Squibb. There are no patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

PY - 2011/12/14

Y1 - 2011/12/14

N2 - Aim: To calculate use, cost and cost-effectiveness of people living with HIV (PLHIV) starting routine treatment and care before starting combination antiretroviral therapy (cART) and PLHIV starting first-line 2NRTIs+NNRTI or 2NRTIs+PI boosted, comparing PLHIV with CD4≤200 cells/mm3 and CD4>200 cells/mm3. Few studies have calculated the use, cost and costeffectiveness of routine treatment and care before starting cART and starting cART above and below CD4 200 cells/mm3. Methods: Use, costs and cost-effectiveness were calculated for PLHIV in routine pre-cART and starting first-line cART, comparing CD4≤200 cells/mm3 with CD4>200 cells/mm3 (2008 UK prices). Results: cART naïve patients CD4≤200 cells/mm3 had an annual cost of £6,407 (95%CI £6,382 to £6,425) PPY compared with £2,758 (95%CI £2,752 to £2,761) PPY for those with CD4>200 cells/mm3; cost per life year gained of pre-cART treatment and care for those with CD4>200 cells/mm3 was £1,776 (cost-saving to £2,752). Annual cost for starting 2NRTIs+NNRTI or 2NRTIs+PI boosted with CD4≤200 cells/mm3 was £12,812 (95%CI £12,685-£12,937) compared with £10,478 (95%CI £10,376-£10,581) for PLHIV with CD4>200 cells/mm3. Cost per additional life-year gained on first-line therapy for those with CD4>200 cells/mm3 was £4639 (£3,967 to £2,960). Conclusion: PLHIV starting to use HIV services before CD4≤200 cells/mm3 is cost-effective and enables them to be monitored so they start cART with a CD4>200 cells/mm3, which results in better outcomes and is cost-effective. However, 25% of PLHIV accessing services continue to present with CD4≤200 cells/mm3. This highlights the need to investigate the cost-effectiveness of testing and early treatment programs for key populations in the UK.

AB - Aim: To calculate use, cost and cost-effectiveness of people living with HIV (PLHIV) starting routine treatment and care before starting combination antiretroviral therapy (cART) and PLHIV starting first-line 2NRTIs+NNRTI or 2NRTIs+PI boosted, comparing PLHIV with CD4≤200 cells/mm3 and CD4>200 cells/mm3. Few studies have calculated the use, cost and costeffectiveness of routine treatment and care before starting cART and starting cART above and below CD4 200 cells/mm3. Methods: Use, costs and cost-effectiveness were calculated for PLHIV in routine pre-cART and starting first-line cART, comparing CD4≤200 cells/mm3 with CD4>200 cells/mm3 (2008 UK prices). Results: cART naïve patients CD4≤200 cells/mm3 had an annual cost of £6,407 (95%CI £6,382 to £6,425) PPY compared with £2,758 (95%CI £2,752 to £2,761) PPY for those with CD4>200 cells/mm3; cost per life year gained of pre-cART treatment and care for those with CD4>200 cells/mm3 was £1,776 (cost-saving to £2,752). Annual cost for starting 2NRTIs+NNRTI or 2NRTIs+PI boosted with CD4≤200 cells/mm3 was £12,812 (95%CI £12,685-£12,937) compared with £10,478 (95%CI £10,376-£10,581) for PLHIV with CD4>200 cells/mm3. Cost per additional life-year gained on first-line therapy for those with CD4>200 cells/mm3 was £4639 (£3,967 to £2,960). Conclusion: PLHIV starting to use HIV services before CD4≤200 cells/mm3 is cost-effective and enables them to be monitored so they start cART with a CD4>200 cells/mm3, which results in better outcomes and is cost-effective. However, 25% of PLHIV accessing services continue to present with CD4≤200 cells/mm3. This highlights the need to investigate the cost-effectiveness of testing and early treatment programs for key populations in the UK.

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The cost-effectiveness of early access to HIV services and starting cART in the UK 1996-2008

Abstract

Bibliographical note

UN SDGs

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