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Home >> Publications >> Cost-effectiveness of first-line antiretroviral therapy for HIV-infected African children less than 3 years of age.

Publication

Author(s):

Ciaranello AL, Doherty K, Penazzato M, Lindsey JC, Harrison L, Kelly K, Walensky RP, Essajee S, Losina E, Muhe L, Wools-Kaloustian K, Ayaya S, Weinstein MC, Palumbo P, Freedberg KA.

Pub Title:

Cost-effectiveness of first-line antiretroviral therapy for HIV-infected African children less than 3 years of age.

Pub Date:

Jun 19 2015

Page Number:
1247-59

Journal:

Title: 
AIDS
Link: 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4536981/

PubMed: 25870982
Pub PDF: PDF icon aids-29-1247.pdf

BACKGROUND:

The International Maternal, Pediatric, and Adolescent Clinical Trials P1060 trial demonstrated superior outcomes for HIV-infected children less than 3 years old initiating antiretroviral therapy (ART) with lopinavir/ritonavir compared to nevirapine, but lopinavir/ritonavir is four-fold costlier.

DESIGN/METHODS:

We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-Pediatric model, with published and P1060 data, to project outcomes under three strategies: no ART; first-line nevirapine (with second-line lopinavir/ritonavir); and first-line lopinavir/ritonavir (second-line nevirapine). The base-case examined South African children initiating ART at age 12 months; sensitivity analyses varied all key model parameters. Outcomes included life expectancy, lifetime costs, and incremental cost-effectiveness ratios [ICERs; dollars/year of life saved ($/YLS)]. We considered interventions with ICERs less than 1× per-capita gross domestic product (South Africa: $7500)/YLS as 'very cost-effective,' interventions with ICERs below 3× gross domestic product/YLS as 'cost-effective,' and interventions leading to longer life expectancy and lower lifetime costs as 'cost-saving'.

RESULTS:

Projected life expectancy was 2.8 years with no ART. Both ART regimens markedly improved life expectancy and were very cost-effective, compared to no ART. First-line lopinavir/ritonavir led to longer life expectancy (28.8 years) and lower lifetime costs ($41 350/person, from lower second-line costs) than first-line nevirapine (27.6 years, $44 030). First-line lopinavir/ritonavir remained cost-saving or very cost-effective compared to first-line nevirapine unless: liquid lopinavir/ritonavir led to two-fold higher virologic failure rates or 15-fold greater costs than in the base-case, or second-line ART following first-line lopinavir/ritonavir was very ineffective.

CONCLUSIONS:

On the basis of P1060 data, first-line lopinavir/ritonavir leads to longer life expectancy and is cost-saving or very cost-effective compared to first-line nevirapine. This supports WHO guidelines, but increasing access to pediatric ART is critical regardless of the regimen used.

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Citation:

Ciaranello AL, Doherty K, Penazzato M, Lindsey JC, Harrison L, Kelly K, Walensky RP, Essajee S, Losina E, Muhe L, Wools-Kaloustian K, Ayaya S, Weinstein MC, Palumbo P, Freedberg KA. Cost-effectiveness of first-line antiretroviral therapy for HIV-infected African children less than 3 years of age. AIDS. 2015 Jun 19;29(10):1247-59. doi: 10.1097/QAD.0000000000000672. PubMed PMID: 25870982; PubMed Central PMCID: PMC4536981.