LOGIN

International Epidemiology Databases to Evaluate AIDS

Home >> Publications >> Cost-effectiveness of preventing loss to follow-up in HIV treatment programs: a Côte d'Ivoire appraisal.

Publication

Author(s):

Losina E, Tourê H, Uhler LM, Anglaret X, Paltiel AD, Balestre E, Walensky RP, Messou E, Weinstein MC, Dabis F, Freedberg KA; ART-LINC Collaboration of International Epidemiological Databases to Evaluate AIDS (IeDEA); CEPAC International investigators.

Pub Title:

Cost-effectiveness of preventing loss to follow-up in HIV treatment programs: a Côte d'Ivoire appraisal.

Pub Date:

Oct 31 2009

Journal Issue:

10

Page Number:
e1000173

Journal:

Title: 
PLoS Medicine
Link: 
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1000173

PubMed: 19859538

Abstract
BACKGROUND
: Data from HIV treatment programs in resource-limited settings show extensive rates of loss to follow-up (LTFU) ranging from 5% to 40% within 6 mo of antiretroviral therapy (ART) initiation. Our objective was to project the clinical impact and cost-effectiveness of interventions to prevent LTFU from HIV care in West Africa.

METHODS AND FINDINGS: We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) International model to project the clinical benefits and cost-effectiveness of LTFU-prevention programs from a payer perspective. These programs include components such as eliminating ART co-payments, eliminating charges to patients for opportunistic infection-related drugs, improving personnel training, and providing meals and reimbursing for transportation for participants. The efficacies and costs of these interventions were extensively varied in sensitivity analyses. We used World Health Organization criteria of <3x gross domestic product per capita (3x GDP per capita = US$2,823 for Côte d'Ivoire) as a plausible threshold for "cost-effectiveness." The main results are based on a reported 18% 1-y LTFU rate. With full retention in care, projected per-person discounted life expectancy starting from age 37 y was 144.7 mo (12.1 y). Survival losses from LTFU within 1 y of ART initiation ranged from 73.9 to 80.7 mo. The intervention costing US$22/person/year (e.g., eliminating ART co-payment) would be cost-effective with an efficacy of at least 12%. An intervention costing US$77/person/year (inclusive of all the components described above) would be cost-effective with an efficacy of at least 41%.

CONCLUSIONS: Interventions that prevent LTFU in resource-limited settings would substantially improve survival and would be cost-effective by international criteria with efficacy of at least 12%-41%, depending on the cost of intervention, based on a reported 18% cumulative incidence of LTFU at 1 y after ART initiation. The commitment to start ART and treat HIV in these settings should include interventions to prevent LTFU.

Comment in:

PMID: 19859538 [PubMed - indexed for MEDLINE]

PMCID: PMC2762030

 

The following websites provide guidelines and policies when citing from PubMed®: http://www.ncbi.nlm.nih.gov/books/NBK7243/
http://www.nlm.nih.gov/bsd/policy/cit_format.html

Citation:

Losina E, Touré H, Uhler LM, Anglaret X, Paltiel AD, Balestre E, Walensky RP, Messou E, Weinstein MC, Dabis F, Freedberg KA; ART-LINC Collaboration of International Epidemiological Databases to Evaluate AIDS (IeDEA); CEPAC International investigators. Cost-effectiveness of preventing loss to follow-up in HIV treatment programs: a Côte d'Ivoire appraisal. PLoS Med. 2009 Oct;6(10):e1000173. doi: 10.1371/journal.pmed.1000173. Epub 2009 Oct 27. PubMed PMID: 19859538; PubMed Central PMCID: PMC2762030.