Cost-effectiveness analysis of ‘test and treat’ policy for antiretroviral therapy among heterosexual HIV population in India

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dc.contributor.authorSingh, Malkeeten_US
dc.contributor.authorSharma, Amanen_US
dc.contributor.authorBahuguna, Pankajen_US
dc.contributor.authorJyani, Gauraven_US
dc.contributor.authorPrinja, Shankaren_US
dc.date.accessioned2023-08-19T04:52:29Z
dc.date.available2023-08-19T04:52:29Z
dc.date.issued2022-12
dc.description.abstractBackground & objectives: The World Health Organisation recommended immediate initiation of antiretroviral therapy (ART) in all adult human immunodeficiency virus (HIV) patients regardless of their CD4 cell count. This study was undertaken to ascertain the cost-effectiveness of implementation of these guidelines in India. Methods: A Markov model was developed to assess the lifetime costs and health outcomes of three scenarios for initiation of ART treatment at varying CD4 cell count <350/mm3, <500/mm3 and test and treat using health system perspective using life-time horizon. A few input parameters for this model namely, transition probabilities from one stage to another stage of HIV and incidence rates of TB were calculated from the data of Centre of Excellence for HIV treatment and care, Chandigarh; whereas, other parameters were obtained from the published literature. Total HIV-related deaths averted, HIV infections averted and incremental cost-effectiveness ratio per quality adjusted life years (QALYs) gained were calculated. Result: Test and treat intervention slowed down the progression of disease and averted 18,386 HIV-related deaths, over lifetime horizon. It also averted 16,105 new HIV infections and saved 343,172 QALYs as compared to the strategy of starting ART at CD4 cell count of 500/mm3. Incremental cost per QALY gained for the immediate initiation of ART as compared to ART at CD4 cell count of 500/mm3 and 350/mm3 was ? 46,599 and 80,050, respectively at reported rates of adherence to the therapy. Interpretation & conclusions: Immediate ART (test and treat) is highly cost-effective strategy over the past criteria of delayed therapy in India. Cost-effectiveness of this policy is largely because of reduction in the transmission of HIVen_US
dc.identifier.affiliationsDepartments ofen_US
dc.identifier.affiliationsCommunity Medicine & School of Public Healthen_US
dc.identifier.affiliationsInternal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, Indiaen_US
dc.identifier.citationSingh Malkeet, Sharma Aman, Bahuguna Pankaj, Jyani Gaurav, Prinja Shankar. Cost-effectiveness analysis of ‘test and treat’ policy for antiretroviral therapy among heterosexual HIV population in India. Indian Journal of Medical Research. 2022 Dec; 156(6): 705-714en_US
dc.identifier.issn0971-5916
dc.identifier.placeIndiaen_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/223697
dc.languageenen_US
dc.publisherWolters Kluwer – Medknowen_US
dc.relation.issuenumber6en_US
dc.relation.volume156en_US
dc.source.urihttps://doi.org/10.4103/ijmr.IJMR_806_20en_US
dc.subjectAntiretroviral therapyen_US
dc.subjectCD4en_US
dc.subjectcost-effectiveness analysesen_US
dc.subjecteconomic evaluationen_US
dc.subjectHIVen_US
dc.subjectIndiaen_US
dc.subjectmodellingen_US
dc.subjecttest and treaten_US
dc.titleCost-effectiveness analysis of ‘test and treat’ policy for antiretroviral therapy among heterosexual HIV population in Indiaen_US
dc.typeJournal Articleen_US
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