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2006 Releases

Dramatic Increase in Life Expectancy Possible for HIV-Infected Patients in Poor Countries using Cost-Effective Antiretroviral Therapy

For immediate release: September 14, 2006  

Boston, MA --The use of potent antiretroviral medications has transformed the AIDS epidemic where people have access to these drugs.  Markedly lower drug costs and the dramatic rise in global funding for HIV/AIDS treatment have made it possible to provide antiretroviral therapy in settings with limited resources.  But there remain important, crucial questions about when to start treatment and whether costly diagnostic tests are necessary to guide treatment decisions.

Analyzing the cost-effectiveness of treatment in one such setting, Harvard School of Public Health researchers and an international team of colleagues have found that prophylactic treatment with co-trimoxazole and antiretroviral therapy will extend life in HIV-infected patients in poor countries and is an economically attractive health investment. Their analysis, “Cost-Effectiveness of HIV Treatment in Resource-Poor Settings – The Case of Côte d’Ivoire,” appears in the September 14, 2006 issue of The New England Journal of Medicine ( (NEJM 2006; 355:1141-53)

The analysis was led by Dr. Sue Goldie, Professor of Health Decision Science and Director, Program in Health Decision Science at HSPH and by Dr. Kenneth Freedberg, Associate Professor in the Department of Health Policy and Management at HSPH and Director, HIV Clinical Research Program at Massachusetts General Hospital.

The international team of researchers synthesized data from multiple studies conducted in Côte d’Ivoire and from the scientific literature to assess the long-term clinical and economic outcomes associated with HIV treatment for HIV-infected adults in Côte d’Ivoire. The researchers used a validated computer-based model that simulates the natural course of HIV disease and combines information on treatment efficacy with other relevant demographic and epidemiological data. They evaluated treatment strategies that differed according to when antiretroviral therapy was started, whether CD4 cell blood tests were done to guide decisions, how many regimens of antiretroviral therapy were available, and whether a medication to prevent common infections was also used. The model produced estimates of gains in life expectancy, costs, and cost-effectiveness for different treatment approaches.

The research team found that by far the most effective treatment strategy was to use antiretroviral therapy to treat HIV disease together with co-trimoxazole to prevent AIDS-related infections. For treatment strategies relying only on clinical information, it was far more beneficial to start antiretroviral therapy after the first severe AIDS-related infection, rather than waiting until two or three occurred.  Treatment approaches that used CD4 tests to guide decisions about starting and stopping antiretroviral therapy, although more costly, were much more effective than approaches that didn’t use these tests. When added to co-trimoxazole prophylaxis, this approach provided a gain in life expectancy of nearly 4 years per person. These survival benefits exceed those associated with many other well-accepted public health interventions.  Dr. Goldie noted: “This analysis demonstrates the remarkable direct per-person benefit of treatment for HIV in Africa, as well as the value of laboratory tests to make the therapy most effective.”

The relationship between the cost of a treatment strategy and the gain in life expectancy associated with that strategy is expressed using a cost-effectiveness ratio or a “cost per year of life saved”. This provides a way to compare the health value gained from investing resources into alternative strategies to improve health. When added to co-trimoxazole prophylaxis, antiretroviral therapy with the use of CD4 tests cost $1,180 per year of life saved in Côte d’Ivoire.  The international Commission on Macroeconomics and Health considers any intervention with a cost per year of life saved less than three times the country’s per capita gross domestic product to be a “good buy”, suggesting that this strategy would be considered cost-effective.

According to Dr. Freedberg: “The money being spent by the United States and other wealthy countries on HIV care in resource-limited countries is an extremely good investment of health dollars and should be continued and expanded.”

This analysis was funded by the US National Institute of Allergy and Infectious Diseases (NIAID), the French Agence Nationale du Recherches sur le SIDA, and the United States Centers for Disease Control and Prevention (CDC).

For further information contact: Robin Herman

(617) 432-4388