The Cost Effectiveness of Combination Antiretroviral Therapy for HIV Disease [Freedberg KA, et al. NEJM 2001;344:824]: This is a report from the MGH, Harvard Medical School, Boston University School of Public Health, Harvard School of Public Health, and Yale School of Medicine with an attempt to define the clinical benefits and cost effectiveness of HAART. The authors developed a mathematical model for HIV disease based on CD4 count and viral load of predictors of progression and costs based on prior reports from HCSUS. The results showed that compared with no therapy, the use of HAART increased life expectancy from 1.97 years to 3.51 years; the increase for quality-adjusted years of life was 1.53 years to 2.91 years. The resulting cost ranged from $13,000 - $23,000 per quality-adjusted year of life gained. With higher CD4 cell counts, the gains were greater and the costs per quality-adjusted year of life saved was lower. The CD4 count and drug costs were the most important determents for clinical benefit, cost, and cost-effectiveness.
Comment: This paper compliments the two prior reports above, the report from the CDC documenting increased longevity and the HCSUS data concerning cost of care. The bottom line is that the cost of HAART per quality-adjusted year of life saved is $13,000 - $23,000 depending largely on the baseline CD4 cell count. It should be noted that other medical procedures that are customary in medical practice such as mammograms at $50,000/QALY or coronary by-pass at $113,000/QALY. Other interventions that have become standard for HIV are PCP prophylaxis at $16,000/QALY, MAC prophylaxis at $58,000/QALY [JAMA 1998;279:130]
posted 3/23/2001

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