The European Journal of Health Economics

, Volume 7, Issue 1, pp 30–36

Comparing costs and effectiveness of different starting points for highly active antiretroviral therapy in HIV-positive patients

Evidence from the ICONA cohort
  • Monica Merito
  • Patrizio Pezzotti
  • for the ICONA Study Group
Original Papers

DOI: 10.1007/s10198-005-0327-9

Cite this article as:
Merito, M., Pezzotti, P. & for the ICONA Study Group Eur J Health Econ (2006) 7: 30. doi:10.1007/s10198-005-0327-9


We evaluated the costs and effectiveness of starting highly active antiretroviral therapy (HAART) at different points during the course of HIV infection, defined on the basis of CD4 T-lymphocytes counts. The study considered 3,250 HAART-naive patients of the Italian Cohort Naive Antiretrovirals (ICONA), enrolled and followed between 1997 and 2002. In correspondence to the thresholds of 500, 350, and 200 CD4 cells/mm3, we selected immediate and deferred groups accounting for lead-time bias. The effects of immediate vs. deferred treatment on AIDS-free survival and direct health costs were estimated stratifying on the propensity score of immediate HAART initiation. The incremental cost-effectiveness ratio (ICER) and the cost-effectiveness acceptability curve were also obtained. Although immediate HAART initiation did not affect incidence AIDS and death at high CD4 levels, starting HAART with 200–349 CD4 cells/mm3 rather than deferring it below 200 CD4 cells/mm3, proved to be cost-effective.


HIV/AIDSHighly active antiretroviral therapy initiationHealth costsLead-timePropensity scores

Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  • Monica Merito
    • 1
    • 3
  • Patrizio Pezzotti
    • 2
  • for the ICONA Study Group
  1. 1.Sant’Anna School of Advanced StudiesPisaItaly
  2. 2.Centro Operativo AIDSIstituto Superiore di SanitàRomeItaly
  3. 3.Laboratory of Economics and ManagementScuola Superiore Sant’AnnaPisaItaly