Health economics modeling of antiretroviral interventions amongst HIV serodiscordant couples

Abstract Antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) for HIV-serodiscordant couples, effectively reduce mortality, transmission events and influence quality of life at the expense of increased costs. We aimed to evaluate health economics of antiretroviral-based strategies for...

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Autores principales:	Haisheng Wu, Qiuyan Yu, Liping Ma, Lin Zhang, Yuliang Chen, Pi Guo, Peng Xu
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/7f6e308683924d079c2cd3ca1936eab3
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spelling	oai:doaj.org-article:7f6e308683924d079c2cd3ca1936eab32021-12-02T16:14:47ZHealth economics modeling of antiretroviral interventions amongst HIV serodiscordant couples10.1038/s41598-021-93443-x2045-2322https://doaj.org/article/7f6e308683924d079c2cd3ca1936eab32021-07-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-93443-xhttps://doaj.org/toc/2045-2322Abstract Antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) for HIV-serodiscordant couples, effectively reduce mortality, transmission events and influence quality of life at the expense of increased costs. We aimed to evaluate health economics of antiretroviral-based strategies for HIV-serodiscordant couples in the China context. A deterministic model of HIV evolution and transmission within a cohort of serodiscordant couples was parameterized using the real-world database of Zhoukou city and published literature. We evaluated the mid-ART (a historical strategy, initiating ART with CD4 < 500 cells/mm3), early-ART (the current strategy, offering ART regardless of CD4 cell counts) and a hypothetical strategy (early-ART combined short-term daily PrEP) versus the late-ART (the baseline strategy, initiating ART with CD4 < 350 cells/mm3) offered by 2008 national guidelines. We estimated the incremental cost-effectiveness ratios (ICER) and incremental cost-utility ratios (ICUR) from a societal perspective, derived by clinical benefits and HIV-caused life quality respectively, and portrayed their changes over a 0–30 year’s timeframe. The model projections indicated that the antiretroviral-based interventions were more likely to obtain clinical benefits but difficult to improve quality of life, and cumulative ICER and ICUR were generally decreasing without achieving cost-saving. Scale-up access to ART for the HIV-positive among serodiscordant couples was easily fallen within the range of paying for incremental life-years and quality adjusted life years by the societal willingness. The hypothetical strategy had the potential to prevent most seroconversion events within marriages but required enormous upfront costs, thus it took a long time to reach established thresholds. The current strategy of early-ART is the most cost-effective. Clarifying the obstacles of high cost of PrEP and improving life quality for HIV-serodiscordant couples have emerged as an urgent requisition.Haisheng WuQiuyan YuLiping MaLin ZhangYuliang ChenPi GuoPeng XuNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-13 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Haisheng Wu Qiuyan Yu Liping Ma Lin Zhang Yuliang Chen Pi Guo Peng Xu Health economics modeling of antiretroviral interventions amongst HIV serodiscordant couples
description	Abstract Antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) for HIV-serodiscordant couples, effectively reduce mortality, transmission events and influence quality of life at the expense of increased costs. We aimed to evaluate health economics of antiretroviral-based strategies for HIV-serodiscordant couples in the China context. A deterministic model of HIV evolution and transmission within a cohort of serodiscordant couples was parameterized using the real-world database of Zhoukou city and published literature. We evaluated the mid-ART (a historical strategy, initiating ART with CD4 < 500 cells/mm3), early-ART (the current strategy, offering ART regardless of CD4 cell counts) and a hypothetical strategy (early-ART combined short-term daily PrEP) versus the late-ART (the baseline strategy, initiating ART with CD4 < 350 cells/mm3) offered by 2008 national guidelines. We estimated the incremental cost-effectiveness ratios (ICER) and incremental cost-utility ratios (ICUR) from a societal perspective, derived by clinical benefits and HIV-caused life quality respectively, and portrayed their changes over a 0–30 year’s timeframe. The model projections indicated that the antiretroviral-based interventions were more likely to obtain clinical benefits but difficult to improve quality of life, and cumulative ICER and ICUR were generally decreasing without achieving cost-saving. Scale-up access to ART for the HIV-positive among serodiscordant couples was easily fallen within the range of paying for incremental life-years and quality adjusted life years by the societal willingness. The hypothetical strategy had the potential to prevent most seroconversion events within marriages but required enormous upfront costs, thus it took a long time to reach established thresholds. The current strategy of early-ART is the most cost-effective. Clarifying the obstacles of high cost of PrEP and improving life quality for HIV-serodiscordant couples have emerged as an urgent requisition.
format	article
author	Haisheng Wu Qiuyan Yu Liping Ma Lin Zhang Yuliang Chen Pi Guo Peng Xu
author_facet	Haisheng Wu Qiuyan Yu Liping Ma Lin Zhang Yuliang Chen Pi Guo Peng Xu
author_sort	Haisheng Wu
title	Health economics modeling of antiretroviral interventions amongst HIV serodiscordant couples
title_short	Health economics modeling of antiretroviral interventions amongst HIV serodiscordant couples
title_full	Health economics modeling of antiretroviral interventions amongst HIV serodiscordant couples
title_fullStr	Health economics modeling of antiretroviral interventions amongst HIV serodiscordant couples
title_full_unstemmed	Health economics modeling of antiretroviral interventions amongst HIV serodiscordant couples
title_sort	health economics modeling of antiretroviral interventions amongst hiv serodiscordant couples
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/7f6e308683924d079c2cd3ca1936eab3
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Health economics modeling of antiretroviral interventions amongst HIV serodiscordant couples

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