Twenty Years Of Antiretroviral Therapy For People Living With HIV: Global Costs, Health Achievements, Economic Benefits

Forsythe, Steven; McGreevey, William Paul; Whiteside, Alan; Shah, Maunank; Cohen, Joshua; Hecht, Robert; Bollinger, L; Kinghorn, Anthony

doi:10.1377/hlthaff.2018.05391

Cited by 73 publications

(47 citation statements)

References 25 publications

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“…For example, we evaluated four HIV/AIDS interventions, and they all, except the provision of cotrimoxazole for children, have an ACER of less than US$100 per HLY gained. The relatively low ACER in this study may partly reflect the decrement of the price of ART drugs as is shown in several recent studies [ 39 , 40 ].…”

Section: Discussionmentioning

confidence: 54%

Generalised cost-effectiveness analysis of 159 health interventions for the Ethiopian essential health service package

Eregata,

Hailu,

Stenberg

et al. 2021

Cost Eff Resour Alloc

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Background Cost effectiveness was a criterion used to revise Ethiopia’s essential health service package (EHSP) in 2019. However, there are few cost-effectiveness studies from Ethiopia or directly transferable evidence from other low-income countries to inform a comprehensive revision of the Ethiopian EHSP. Therefore, this paper reports average cost-effectiveness ratios (ACERs) of 159 health interventions used in the revision of Ethiopia’s EHSP. Methods In this study, we estimate ACERs for 77 interventions on reproductive maternal neonatal and child health (RMNCH), infectious diseases and water sanitation and hygiene as well as for 82 interventions on non-communicable diseases. We used the standardised World Health Organization (WHO) CHOosing Interventions that are cost effective methodology (CHOICE) for generalised cost-effectiveness analysis. The health benefits of interventions were determined using a population state-transition model, which simulates the Ethiopian population, accounting for births, deaths and disease epidemiology. Healthy life years (HLYs) gained was employed as a measure of health benefits. We estimated the economic costs of interventions from the health system perspective, including programme overhead and training costs. We used the Spectrum generalised cost-effectiveness analysis tool for data analysis. We did not explicitly apply cost-effectiveness thresholds, but we used US$100 and $1000 as references to summarise and present the ACER results. Results We found ACERs ranging from less than US$1 per HLY gained (for family planning) to about US$48,000 per HLY gained (for treatment of stage 4 colorectal cancer). In general, 75% of the interventions evaluated had ACERs of less than US$1000 per HLY gained. The vast majority (95%) of RMNCH and infectious disease interventions had an ACER of less than US$1000 per HLY while almost half (44%) of non-communicable disease interventions had an ACER greater than US$1000 per HLY. Conclusion The present study shows that several potential cost-effective interventions are available that could substantially reduce Ethiopia’s disease burden if scaled up. The use of the World Health Organization’s generalised cost-effectiveness analysis tool allowed us to rapidly calculate country-specific cost-effectiveness analysis values for 159 health interventions under consideration for Ethiopia’s EHSP.

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Section: Discussionmentioning

confidence: 54%

Generalised cost-effectiveness analysis of 159 health interventions for the Ethiopian essential health service package

Eregata,

Hailu,

Stenberg

et al. 2021

Cost Eff Resour Alloc

View full text Add to dashboard Cite

show abstract

“…For example, we evaluated four HIV/AIDS interventions, and they all, except the provision of cotrimoxazole for children, have an ACER of less than US$100 per HLY gained. The relatively low ACER in this study may partly re ect the decrement of the price of ART drugs as is shown in several recent studies [38,39].…”

Section: Discussionmentioning

confidence: 58%

Generalised Cost-Effectiveness Analysis of 159 Health Interventions For The Ethiopian Essential Health Service Package

Teshome¹,

Hailu²,

Stenberg

et al. 2020

Preprint

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Background: Cost effectiveness was a criterion used to revise Ethiopia’s essential health service package (EHSP) in 2019. However, there are few cost-effectiveness studies from Ethiopia or directly transferable evidence from other low-income countries to inform a comprehensive revision of the Ethiopian EHSP. Therefore, this paper reports average cost-effectiveness ratios (ACERs) of 159 health interventions used in the revision of Ethiopia’s EHSP. Methods: In this study, we estimate ACERs for 77 interventions on reproductive maternal neonatal and child health (RMNCH), infectious diseases and water sanitation and hygiene as well as for 82 interventions on non-communicable diseases. We used the standardised World Health Organization CHOosing Interventions that are Cost Effective methodology for generalised cost-effectiveness analysis. The health benefits of interventions were determined using a population state-transition model, which simulates the Ethiopian population, accounting for births, deaths and disease epidemiology. Healthy life years (HLYs) gained was employed as a measure of health benefits, and we estimated the economic costs of interventions from the health system perspective, including programme overhead and training costs. We used the Spectrum generalised cost-effectiveness analysis tool for data analysis. We did not explicitly apply cost-effectiveness thresholds, but we used US$100 and $1,000 as references to summarise and present the ACER results. Results: We found ACERs ranging from less than US$1 per HLY gained (for family planning) to about US$48,000 per HLY gained (for treatment of stage 4 colorectal cancer). In general, 75% of the interventions evaluated had ACERs of less than US$1,000 per HLY gained. The vast majority (95%) of RMNCH and infectious disease interventions had an ACER of less than US$1,000 per HLY while almost half (44%) of non-communicable disease interventions had an ACER greater than US$1,000 per HLY. Conclusion: The present study shows that several potential cost-effective interventions are available that could substantially reduce Ethiopia’s disease burden if scaled up. The use of the World Health Organization’s generalised cost-effectiveness analysis tool allowed us to rapidly calculate country-specific cost-effectiveness analysis values for 159 health interventions under consideration for Ethiopia’s EHSP.

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“…Improvements in post-CPR care in general would be expected to be slower than those observed in the present study. Alternatively, it is possible that the rising use of cART [25] has contributed to the improved short-term survival among HIV-infected hospitalizations that had undergone in-hospital CPR. The latter factor would be expected to improve hospital mortality among all HIV hospitalizations and those with in-hospital CPR.…”

Section: Relationship To Prior Studiesmentioning

confidence: 99%

In-Hospital Cardiopulmonary Resuscitation of Patients With Human Immunodeficiency Virus Infection: A Population-Based Cohort Study of Epidemiology and Outcomes

Oud

2020

J Clin Med Res

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Background: Marked improvements were realized in both shortterm and long-term outcomes of human immunodeficiency virus (HIV)-infected patients following the introduction of combination antiretroviral therapy. However, the contemporary population-level patterns of in-hospital cardiopulmonary resuscitation (CPR) and the outcomes of HIV-infected patients were not systematically examined. Methods:We used the Texas Inpatient Public Use Data File to identify hospitalizations aged ≥ 18 years with and without HIV during 2009 -2014, and those in each group who have undergone in-hospital CPR. Short-term survival (defined as absence of hospital mortality or discharge to hospice) following in-hospital CPR was examined. Multivariate logistic regression modeling was used to assess the prognostic impact of HIV infection following in-hospital CPR and predictors of short-term survival among HIV hospitalizations. Results:In-hospital CPR was reported in 437 and 54,135 hospitalizations with and without HIV, respectively. The rates of in-hospital CPR (per 1,000 hospitalizations) were 4.4 and 4.1 among hospitalizations with and without HIV, respectively (P = 0.1659). The corresponding rates of in-hospital CPR among decedents were 11% and 11.8%, respectively (P = 0.1531). Crude short-term survival following in-hospital CPR among hospitalizations with and without HIV was 19% and 26.8%, respectively (P = 0.0003). The corresponding adjusted short-term survival between 2009 and 2014 rose from 14.2% to 27% (P = 0.0009 for trend) and from 25.5% to 28% (P < 0.0001 for trend). HIV infection was associated with lower odds of shortterm survival following in-hospital CPR (adjusted odds ratio (aOR): 0.50, 95% confidence interval (95% CI): 0.39 -0.65). Select comorbid conditions (congestive heart failure, aOR: 2.03, 95% CI: 1.20 -2.46; cerebrovascular disease, aOR: 2.08, 95% CI: 1.15 -3.75; and diabetes, aOR: 1.53, 95% CI 1.31 -4.71) were the only independent predictors of short-term survival following in-hospital CPR among HIV hospitalizations. Conclusions:The rates of in-hospital CPR were similar among hospitalizations with and without HIV infection, with similar level of selectivity among decedents. Although HIV infection was associated with lower short-term survival following in-hospital CPR for the whole cohort, a dramatic improvement was observed during the study period among affected patients, with short-term survival rates becoming near-similar to those without HIV. Further studies are needed to identify modifiable factors to further improve the outcomes following in-hospital CPR among patients with HIV infection.

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Twenty Years Of Antiretroviral Therapy For People Living With HIV: Global Costs, Health Achievements, Economic Benefits

Cited by 73 publications

References 25 publications

Generalised cost-effectiveness analysis of 159 health interventions for the Ethiopian essential health service package

Generalised cost-effectiveness analysis of 159 health interventions for the Ethiopian essential health service package

Generalised Cost-Effectiveness Analysis of 159 Health Interventions For The Ethiopian Essential Health Service Package

In-Hospital Cardiopulmonary Resuscitation of Patients With Human Immunodeficiency Virus Infection: A Population-Based Cohort Study of Epidemiology and Outcomes

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