Antiretroviral Therapy and HIV Prevention in India: Modeling Costs and Consequences of Policy Options
Objectives: The objective of this study is to assess the costs, costeffectiveness, and HIV epidemic impact of 3 antiretroviral therapy (ART) policy options. Study Design: We constructed an epidemiologic model to predict the course of the HIV epidemic in the absence of expanded ART availability. Base...
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| Veröffentlicht in: | Sexually transmitted diseases 2006-10, Vol.33 (10), p.S145-S152 |
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| creator | OVER, MEAD MARSEILLE, ELLIOT SUDHAKAR, KURAPATI GOLD, JULIAN GUPTA, INDRANI INDRAYAN, ABHAYA HIRA, SUBHASH NAGELKERKE, NICO RAO, ARNI S. R. SRINIVASA HEYWOOD, PETER |
| description | Objectives: The objective of this study is to assess the costs, costeffectiveness, and HIV epidemic impact of 3 antiretroviral therapy (ART) policy options. Study Design: We constructed an epidemiologic model to predict the course of the HIV epidemic in the absence of expanded ART availability. Based on background studies of the willingness to pay for ART among patients with AIDS, of the costs to the government of the alternative treatment interventions, and of ART's likely effects on HIV transmission, we simulated the consequences of 3 possible alternative government ART policies. Results: A program to reduce the negative consequences of the currently unstructured private-sector provision of ART is the most cost-effective of the 3 options at a 10% discount rate and least costeffective at a 3% rate. The costs and cost-effectiveness of all options are highly sensitive to the effect of ART on condom use. Conclusion: The design of ART policy should capitalize on the potential of ART to decrease HIV transmission through institutional arrangements that reward effective prevention programs, thereby raising the likelihood that treatment has beneficial rather than negative external effects. |
| doi_str_mv | 10.1097/01.olq.0000238457.93426.0d |
| format | Article |
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R. SRINIVASA ; HEYWOOD, PETER</creator><creatorcontrib>OVER, MEAD ; MARSEILLE, ELLIOT ; SUDHAKAR, KURAPATI ; GOLD, JULIAN ; GUPTA, INDRANI ; INDRAYAN, ABHAYA ; HIRA, SUBHASH ; NAGELKERKE, NICO ; RAO, ARNI S. R. SRINIVASA ; HEYWOOD, PETER</creatorcontrib><description>Objectives: The objective of this study is to assess the costs, costeffectiveness, and HIV epidemic impact of 3 antiretroviral therapy (ART) policy options. Study Design: We constructed an epidemiologic model to predict the course of the HIV epidemic in the absence of expanded ART availability. Based on background studies of the willingness to pay for ART among patients with AIDS, of the costs to the government of the alternative treatment interventions, and of ART's likely effects on HIV transmission, we simulated the consequences of 3 possible alternative government ART policies. Results: A program to reduce the negative consequences of the currently unstructured private-sector provision of ART is the most cost-effective of the 3 options at a 10% discount rate and least costeffective at a 3% rate. The costs and cost-effectiveness of all options are highly sensitive to the effect of ART on condom use. Conclusion: The design of ART policy should capitalize on the potential of ART to decrease HIV transmission through institutional arrangements that reward effective prevention programs, thereby raising the likelihood that treatment has beneficial rather than negative external effects.</description><identifier>ISSN: 0148-5717</identifier><identifier>EISSN: 1537-4521</identifier><identifier>DOI: 10.1097/01.olq.0000238457.93426.0d</identifier><identifier>PMID: 17003679</identifier><identifier>CODEN: STRDDM</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Antiviral Agents - economics ; Antiviral Agents - therapeutic use ; Cost analysis ; Cost-Benefit Analysis ; Costs and Cost Analysis ; Drug therapy ; Epidemiology ; Government Programs - economics ; Health care policy ; HIV ; HIV Infections - drug therapy ; HIV Infections - economics ; HIV Infections - epidemiology ; HIV Infections - prevention & control ; Human immunodeficiency virus ; Humans ; India - epidemiology ; Models, Theoretical ; Prevention programs ; Public Policy</subject><ispartof>Sexually transmitted diseases, 2006-10, Vol.33 (10), p.S145-S152</ispartof><rights>Copyright © 2006 American Sexually Transmitted Diseases Association</rights><rights>Copyright Lippincott Williams & Wilkins Oct 2006</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c366t-a8c9204d36232e443aad1baa86c71f776e7f5b9f6cb34c98729f6a411acd921c3</citedby><cites>FETCH-LOGICAL-c366t-a8c9204d36232e443aad1baa86c71f776e7f5b9f6cb34c98729f6a411acd921c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/44966574$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/44966574$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,780,784,803,27924,27925,30999,58017,58250</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17003679$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>OVER, MEAD</creatorcontrib><creatorcontrib>MARSEILLE, ELLIOT</creatorcontrib><creatorcontrib>SUDHAKAR, KURAPATI</creatorcontrib><creatorcontrib>GOLD, JULIAN</creatorcontrib><creatorcontrib>GUPTA, INDRANI</creatorcontrib><creatorcontrib>INDRAYAN, ABHAYA</creatorcontrib><creatorcontrib>HIRA, SUBHASH</creatorcontrib><creatorcontrib>NAGELKERKE, NICO</creatorcontrib><creatorcontrib>RAO, ARNI S. R. SRINIVASA</creatorcontrib><creatorcontrib>HEYWOOD, PETER</creatorcontrib><title>Antiretroviral Therapy and HIV Prevention in India: Modeling Costs and Consequences of Policy Options</title><title>Sexually transmitted diseases</title><addtitle>Sex Transm Dis</addtitle><description>Objectives: The objective of this study is to assess the costs, costeffectiveness, and HIV epidemic impact of 3 antiretroviral therapy (ART) policy options. Study Design: We constructed an epidemiologic model to predict the course of the HIV epidemic in the absence of expanded ART availability. Based on background studies of the willingness to pay for ART among patients with AIDS, of the costs to the government of the alternative treatment interventions, and of ART's likely effects on HIV transmission, we simulated the consequences of 3 possible alternative government ART policies. Results: A program to reduce the negative consequences of the currently unstructured private-sector provision of ART is the most cost-effective of the 3 options at a 10% discount rate and least costeffective at a 3% rate. The costs and cost-effectiveness of all options are highly sensitive to the effect of ART on condom use. Conclusion: The design of ART policy should capitalize on the potential of ART to decrease HIV transmission through institutional arrangements that reward effective prevention programs, thereby raising the likelihood that treatment has beneficial rather than negative external effects.</description><subject>Antiviral Agents - economics</subject><subject>Antiviral Agents - therapeutic use</subject><subject>Cost analysis</subject><subject>Cost-Benefit Analysis</subject><subject>Costs and Cost Analysis</subject><subject>Drug therapy</subject><subject>Epidemiology</subject><subject>Government Programs - economics</subject><subject>Health care policy</subject><subject>HIV</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - economics</subject><subject>HIV Infections - epidemiology</subject><subject>HIV Infections - prevention & control</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>India - epidemiology</subject><subject>Models, Theoretical</subject><subject>Prevention programs</subject><subject>Public Policy</subject><issn>0148-5717</issn><issn>1537-4521</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNpdkU1PJCEQhonR6PjxEzTEw966lwIaGm9msuokbvSgXgkD9G5PemCEHpP59zLOZE2WS1Gp562q1IvQNZAaiJI_CdRxeK9JeZS1vJG1YpyKmrgDNIGGyYo3FA7RhABvq0aCPEGnOS_INidwjE5AEsKEVBPkb8PYJz-m-NEnM-CXvz6Z1Qab4PDD7A0_J__hCxID7gOeBdebG_w7Oj_04Q-exjzmL3YaQ_bvax-szzh2-DkOvd3gp9VWms_RUWeG7C_28Qy93v16mT5Uj0_3s-ntY2WZEGNlWqso4Y4JyqjnnBnjYG5MK6yETkrhZdfMVSfsnHGrWknL33AAY52iYNkZ-rHru0qxLJNHveyz9cNggo_rrEXbKkUYKeD1f-AirlMou2lKKZOiAVqgmx1kU8w5-U6vUr80aaOB6K0TmoAuTuhvJ_SXE5q4Ir7aT1jPl959S_enL8DlDljkMaZ_dc6VEI3k7BMTAI9Z</recordid><startdate>20061001</startdate><enddate>20061001</enddate><creator>OVER, MEAD</creator><creator>MARSEILLE, ELLIOT</creator><creator>SUDHAKAR, KURAPATI</creator><creator>GOLD, JULIAN</creator><creator>GUPTA, INDRANI</creator><creator>INDRAYAN, ABHAYA</creator><creator>HIRA, SUBHASH</creator><creator>NAGELKERKE, NICO</creator><creator>RAO, ARNI S. R. SRINIVASA</creator><creator>HEYWOOD, PETER</creator><general>Lippincott Williams & Wilkins</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QJ</scope><scope>7QL</scope><scope>7T2</scope><scope>7U9</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20061001</creationdate><title>Antiretroviral Therapy and HIV Prevention in India: Modeling Costs and Consequences of Policy Options</title><author>OVER, MEAD ; MARSEILLE, ELLIOT ; SUDHAKAR, KURAPATI ; GOLD, JULIAN ; GUPTA, INDRANI ; INDRAYAN, ABHAYA ; HIRA, SUBHASH ; NAGELKERKE, NICO ; RAO, ARNI S. R. 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R. SRINIVASA</au><au>HEYWOOD, PETER</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Antiretroviral Therapy and HIV Prevention in India: Modeling Costs and Consequences of Policy Options</atitle><jtitle>Sexually transmitted diseases</jtitle><addtitle>Sex Transm Dis</addtitle><date>2006-10-01</date><risdate>2006</risdate><volume>33</volume><issue>10</issue><spage>S145</spage><epage>S152</epage><pages>S145-S152</pages><issn>0148-5717</issn><eissn>1537-4521</eissn><coden>STRDDM</coden><abstract>Objectives: The objective of this study is to assess the costs, costeffectiveness, and HIV epidemic impact of 3 antiretroviral therapy (ART) policy options. Study Design: We constructed an epidemiologic model to predict the course of the HIV epidemic in the absence of expanded ART availability. Based on background studies of the willingness to pay for ART among patients with AIDS, of the costs to the government of the alternative treatment interventions, and of ART's likely effects on HIV transmission, we simulated the consequences of 3 possible alternative government ART policies. Results: A program to reduce the negative consequences of the currently unstructured private-sector provision of ART is the most cost-effective of the 3 options at a 10% discount rate and least costeffective at a 3% rate. The costs and cost-effectiveness of all options are highly sensitive to the effect of ART on condom use. Conclusion: The design of ART policy should capitalize on the potential of ART to decrease HIV transmission through institutional arrangements that reward effective prevention programs, thereby raising the likelihood that treatment has beneficial rather than negative external effects.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>17003679</pmid><doi>10.1097/01.olq.0000238457.93426.0d</doi></addata></record> |
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| subjects | Antiviral Agents - economics Antiviral Agents - therapeutic use Cost analysis Cost-Benefit Analysis Costs and Cost Analysis Drug therapy Epidemiology Government Programs - economics Health care policy HIV HIV Infections - drug therapy HIV Infections - economics HIV Infections - epidemiology HIV Infections - prevention & control Human immunodeficiency virus Humans India - epidemiology Models, Theoretical Prevention programs Public Policy |
| title | Antiretroviral Therapy and HIV Prevention in India: Modeling Costs and Consequences of Policy Options |
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