In the most recent edition of PLoS Medicine, findings of a study conducted by researchers at the Weill Cornell Medical College and GHESKIO (Groupe Haitien d’Etude du Sarcome de Kaposi et des Infections Opportunistes) proves that early treatment of HIV is not only life saving but also cost-effective.
Prior to 2009, the World Health Organization (WHO) recommended not to commence antiretroviral therapy (ART) in HIV patients unless their CD4+ T cells sink below 200 cells per cubic millimeter. However, in the same year, Weill Cornell researchers conducted a randomized clinical trial at the GHESKIO clinic in Port-au-Prince, Haiti, which proved that early ART decreased mortality by 75% in HIV-infected adults with a CD4 cell count between 200 and 350 cells/mm3. These study results provoked the WHO to change their recommendation to start ART in HIV-infected people when their CD4 cell count falls below 350 cells/mm3.
Researchers at Weill Cornell Medical College, GHESKIO, and Brigham and Women’s Hospital in Boston conducted a new study to assess the cost effectiveness of the revised WHO recommendation and whether its benefits outweigh its cost. Medical intervention is generally considered cost-effective if the costs are less than three times a country’s per capita gross domestic product (GDP) per year of life saved (YLS).
Using data from the previous randomized trial to compare the cost-effectiveness of early versus standard ART the new study included the use and costs of ART, other medications, laboratory tests, outpatient visits, radiography, procedures and hospital services in their evaluation.
Findings revealed that patients receiving early ART had higher average costs for ART but lower costs for other aspects of their treatment compared with patients receiving standard ART. When costs of research-related tests were excluded, the incremental cost-effectiveness ratio for early ART compared with standard ART was US $2,050/YLS after three years.
Lead author Dr. Serena P. Koenig, assistant professor at Brigham and Women’s Hospital says: “Because the Haitian GDP per capita is US $785, these findings suggest that, in Haiti, early ART is a cost-effective intervention over the observation period of the trial.”
Senior author Dr. Bruce R. Schackman, associate professor of public health and chief of the Division of Health Policy at Weill Cornell Medical College added:
“The incremental cost-effectiveness ratios calculated in our study are probably conservative because they did not consider the clinical benefits of early ART that continue beyond three years — early ART is associated with lower longer-term mortality than standard ART — or the benefit of early ART on disability and quality of life.”
Dr. Jean W. Pape, founder and director of GHESKIO and professor of medicine at Weill Cornell Medical College concludes:
“This study suggests that the new WHO guidelines for ART initiation can be cost-effective in resource-poor settings. Despite substantial budget and logistical constraints to implementing earlier treatment policymakers should allocate resources to maximize their ability to implement the new guidelines.”
The paper’s other authors include Dr. Daniel W. Fitzgerald, Dr. Warren D. Johnson, Dr. Jean W. Pape, Dr. Heejung Bang and Ms. Alison Edwards from Weill Cornell Medical College and Dr. Patrice Severe, Dr. Marc Antoine Jean Juste, Dr. Alex Ambroise, Dr. Cynthia Riviere, Ms. Jessica Hippolyte, Mr. Jolion McGreevy, Mr. Serge Marcelin and Dr. Rode Secours from GHESKIO.
The U.S. National Institutes of Allergy and Infectious Diseases, the Fogarty International Center, the Global Fund to Fight AIDS, Tuberculosis and Maria, and the Fondation Mérieux, among others, funded the study.
GHESKIO (Groupe Haitien d’Etude du Sarcome de Kaposi et des Infections Opportunistes, or the Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic Infections) is a nongovernmental research and training center internationally renown for its pioneering work in the treatment of HIV and AIDS-related illnesses. Its director Dr. Jean Pape, who is a professor of medicine at Weill Cornell Medical College, founded GHESKIO in 1982. The center maintains a close relationship with Weill Cornell Medical College and since its inception has never closed its doors to patients, not even during the 7.0 magnitude earthquake that struck Haiti in 2010.
Written by Petra Rattue