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The Cost Effectiveness of Antiretroviral Regimens for the Treatment of HIV/AIDS

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Abstract

Objective: To estimate survival, the number of life-years gained and cost effectiveness of antiretroviral therapy (ART) regimens, denoted as ERA-I [zidovudine + (didanosine or zalcitabine)]; ERA-II [stavudine + (didanosine or zalcitabine) or lamivudine + (zidovudine or didanosine or zalcitabine or stavudine)]; and ERA-III [2 nucleoside reverse transcriptase inhibitors + (1 protease inhibitor or 1 non-nucleoside reverse transcriptase inhibitor)].

Design: Modelling of drug cost, cost of opportunistic diseases and survival of HIV-positive men and women in the province of British Columbia who were first prescribed any ART between October 1992 and June 1996. A ‘reference cohort’ was modelled upon individuals in a longitudinal cohort of homosexual men followed since 1982.

Perspective and setting: Third-party payer perspective in BritishColumbia, Canada.

Patients: All HIV-positive men and women aged ≥18 years with CD4+ counts ≤350 cells/μL who were enrolled in the province-wide drug treatment programme. Main outcome measures: Annual costs, survival and cost-effectiveness ratios of successive ART regimens.

Results: Total costs [1997 Canadian dollars ($Can)] at 12 months under ERA-I, -II and -III were $Can4897, $Can6620 and $Can11 914, respectively. Survival at 12 months under ERA-I, -II and -III was 89.6%, 91.0% and 97.6%, respectively. The annual incremental cost (estimated by the total incremental cost at 12months) between ERA-II and ERA-I was $Can1723. The incremental cost-effectiveness ratios between ERA-III and ERA-I, and between ERA-III and ERA-II were $Can58 806 and $Can46 971 per life-year gained, respectively.

Conclusion: We found the cost effectiveness of ERA-III ART regimens well within the range of currently funded therapies for the treatment of other chronic diseases.

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Acknowledgements

This work was supported by the National Health Research Development Programme of the Department of National Health and Welfare of Canada through a National Health Research Scholar Award to Dr Hogg and Dr Montaner, and through a National AIDS Research Scientist Award to Dr Schechter. Dr Anis’s research programme is supported by a grant from the B.C. Ministry of Health and the Ministry responsible for Seniors.

Wethank Diane Campbell, Rita Dewletian, Bonnie Devlin, Elizabeth Ferris, Nada Gataric, Ramona Gomes, Deborah Hamann-Trou, Kelly Hsu, Hector Leon, Tuhin Rahman, Myrna Reginaldo, Diane Skippen and Fatma Telli for their research and administrative assistance.

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Authors and Affiliations

  1. British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia, Canada

    Aslam H. Anis, Robert S. Hogg, Benita Yip, Michael V. O’Shaughnessy, Martin T. Schechter & Julio S. G. Montaner

  2. Canadian HIV Trials Network, Vancouver, British Columbia, Canada

    Aslam H. Anis, Daphne Guh, Xiao-Hua Wang, Kevin J. P. Craib, Michael V. O’Shaughnessy, Martin T. Schechter & Julio S. G. Montaner

  3. Department of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, Canada

    Aslam H. Anis, Robert S. Hogg & Martin T. Schechter

  4. Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada

    Michael V. O’Shaughnessy

  5. Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

    Julio S. G. Montaner

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  1. Aslam H. Anis
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  2. Daphne Guh
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  3. Robert S. Hogg
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  8. Martin T. Schechter
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  9. Julio S. G. Montaner
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Anis, A.H., Guh, D., Hogg, R.S. et al. The Cost Effectiveness of Antiretroviral Regimens for the Treatment of HIV/AIDS. Pharmacoeconomics 18, 393–404 (2000). https://doi.org/10.2165/00019053-200018040-00007

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