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

Evidence from the ICONA cohort

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Abstract

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.

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Acknowledgements

The ICONA network is supported by an unrestricted educational grant provided by GlaxoSmithKline Italy. The members of the ICONA Study Group are: Ancona: M. Montroni, G. Scalise, M.C. Braschi, M.S. Del Prete; Aviano: U. Tirelli, R. Cinelli; Bari: G. Pastore, N. Ladisa, G. Minafra; Bergamo: F. Suter, C. Arici; Bologna: F. Chiodo, V. Colangeli, C. Fiorini, O. Coronado; Brescia: G. Carosi, G.P. Cadeo, C. Torti, C. Minardi, D. Bertelli; Busto Arsizio: G. Rizzardini, G. Migliorino; Cagliari: P.E. Manconi, P. Piano; Catanzaro: T. Ferraro, A. Scerbo; Chieti: E. Pizzigallo, M. D’Alessandro; Como: D. Santoro, L. Pusterla; Cremona: G. Carnevale, D. Galloni; Cuggiono: P. Viganò, M. Mena; Ferrara: F. Ghinelli, L. Sighinolfi; Firenze: F. Leoncini, F. Mazzotta, M. Pozzi, S. Lo Caputo; Foggia: G. Angarano, B. Grisorio, A. Saracino, S. Ferrara; Galatina: P. Grima, P. Tundo; Genova: G. Pagano, G. Cassola, A. Alessandrini, R. Piscopo; Grosseto: M. Toti, S. Chigiotti; Latina: F. Soscia, L. Tacconi; Lecco: A. Orani, P. Perini; Lucca: A. Scasso, A. Vincenti; Macerata: F. Chiodera, P. Castelli; Mantova: A. Scalzini, G. Fibbia; Milan: M. Moroni, A. Lazzarin, A. Cargnel, G.M. Vigevani, L. Caggese, A. d’Arminio Monforte, D. Repetto, R. Novati, A. Galli, S. Merli, C. Pastecchia, M.C. Moioli; Modena: R. Esposito, C. Mussini; Napoli: N. Abrescia, A. Chirianni, C.M. Izzo, M. Piazza, M. De Marco, R. Viglietti, E. Manzillo, M. Graf; Palermo: A. Colomba, V. Abbadessa, T. Prestileo, S. Mancuso; Parma: C. Ferrari, P. Pizzaferri; Pavia: G. Filice, L. Minoli, R. Bruno, S. Novati; Perugia: F. Baldelli, M. Tinca; Pesaro: E. Petrelli, A. Cioppi; Piacenza: F. Alberici, A. Ruggieri; Pisa: F. Menichetti, C. Martinelli; Potenza: C. De Stefano, A. La Gala; Ravenna: G. Ballardini, E. Briganti; Reggio Emilia: G. Magnani, M.A. Ursitti; Rimini: M. Arlotti, P. Ortolani; Roma: R. Cauda, F. Dianzani, G. Ippolito, A. Antinori, G. Antonucci, S. D’Elia, P. Narciso, N. Petrosillo, V. Vullo, A. De Luca, S. Di Giambenedetti, M. Zaccarelli, R. Acinapura, P. De Longis, M. Ciardi, G. D’Offizi, MP Trotta, P. Noto, M. Lichtner, M.R. Capobianchi, E. Girardi, P. Pezzotti, G. Rezza; Sassari: M.S. Mura, M. Mannazzu; Taranto: F. Resta, K. Loso; Torino: P. Caramello, A. Sinicco, M.L. Soranzo, G. Orofino, M. Sciandra, M. Bonasso; Varese: P.A. Grossi, C. Basilico; Verbania: A. Poggio, G. Bottari; Venezia: E. Raise, S. Pasquinucci; Vicenza: F. De Lalla, G. Tositti; London, UK: A. Cozzi Lepri.

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  1. Monica Merito

    Present address: Laboratory of Economics and Management, Scuola Superiore Sant’Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy

Authors and Affiliations

  1. Sant’Anna School of Advanced Studies, Pisa, Italy

    Monica Merito

  2. Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy

    Patrizio Pezzotti

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  1. Monica Merito
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for the ICONA Study Group

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Correspondence to Monica Merito.

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See “Acknowledgements” for the members of the ICONA Study Group

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Merito, M., Pezzotti, P. & for the ICONA Study Group. Comparing costs and effectiveness of different starting points for highly active antiretroviral therapy in HIV-positive patients. Eur J Health Econ 7, 30–36 (2006). https://doi.org/10.1007/s10198-005-0327-9

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  • DOI: https://doi.org/10.1007/s10198-005-0327-9

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