Medication costs associated with early initiation of antiretroviral therapy

AIDS Care
Richard M Grimes, Deanna E Grimes

Abstract

The START Study randomly assigned 4685 persons with CD4+ counts >500 to either immediate treatment (2326 persons) or a group (2359) that had treatment delayed until the CD4+ count was <350 or clinical judgment dictated treatment. The average time in the study was three years. The immediate group (IG) had 42 serious clinical events and the delayed group (DG) had 96. Policy considerations for adopting these results should consider the cost of medications for early treatment, which is the purpose of this article. Cost of early treatment was estimated by assuming the delayed treatment group had been treated for the three-year average course of the study. However, 48% of the DG received ART before the study's end, so that portion of the group's time on ART was reduced to 1.5 years. Average wholesale prices in the United States of the five recommended ART regimens were discounted by 50% to reflect actual pricing. An average medication cost for the five regimens of $20,000 per person year was used. The three-year cost was $107,580,000 for the 52% who would have been treated for three years and for the 48% treated for an average of 1.5 years. The cost per clinical event avoided was $1,992,222. Formulae are provided that will allow the ...Continue Reading

References

Jul 20, 2011·The New England Journal of Medicine·Myron S CohenUNKNOWN HPTN 052 Study Team
Jan 24, 2012·Journal of Acquired Immune Deficiency Syndromes : JAIDS·H Irene HallJonathan Mermin
Nov 15, 2013·Journal of Acquired Immune Deficiency Syndromes : JAIDS·Ira B WilsonUNKNOWN Multisite Adherence Collaboration on HIV 14 Investigators
Jul 21, 2015·The New England Journal of Medicine·UNKNOWN INSIGHT START Study GroupJames D Neaton
Apr 4, 2017·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Annabelle GourlayUNKNOWN European HIV Continuum of Care Working Group
Jun 21, 2017·Journal of the International AIDS Society·Jessica E HabererDavid R Bangsberg

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