Cost-effectiveness of alternative strategies for initiating and monitoring highly active antiretroviral therapy in the developing world.

OBJECTIVE Determine the cost-effectiveness of initiating and monitoring highly active antiretroviral therapy (HAART) in developing countries according to developing world versus developed world guidelines. DESIGN Lifetime Markov model incorporating costs, quality of life, survival, and transmission to sexual contacts. METHODS We evaluated treating patients with HIV in South Africa according to World Health Organization (WHO) "3 by 5" guidelines (treat CD4 counts 100,000 copies/mL, and monitor CD4 cell counts and viral load every 3 months. RESULTS Incorporating transmission to partners (excluding indirect costs), treating patients according to developed versus developing world guidelines increased costs by US $11,867 and increased life expectancy by 3.00 quality-adjusted life-years (QALYs), for an incremental cost-effectiveness of $3956 per QALY. Including indirect costs, over the duration of the model, there are net cost savings to the economy of $39.4 billion, with increased direct medical costs of $60.5 billion offset by indirect cost savings of $99.9 billion. CONCLUSIONS Treating patients with HIV according to developed versus developing world guidelines is highly cost-effective and may result in substantial long-term savings.