Modeling the cost-effectiveness of HIV treatment: how to buy the most 'health' when resources are limited

Purpose of reviewTo summarize recent cost-effectiveness analyses (CEAs) that evaluate optimal treatment strategies for persons living with HIV/AIDS (PLWHA).Recent findingsEfforts to attain universal coverage of current treatment guidelines (e.g., initiation at CD4(+) cell count <350cells/l) are generally very costeffective. Expansion of access beyond current guidelines will additionally improve clinical outcomes and aversion of new HIV infections; however, cost-effectiveness is more uncertain. Increasing access to antiretroviral therapy (ART) offers greater health benefit than investing the same funds in intensive laboratory monitoring for those on ART, particularly in those settings in which universal coverage has not yet been attained. Recommended ART regimens (e.g., tenofovir) have favorable cost-effectiveness when compared with substitution of newer, more expensive agents (e.g., rilpivirine, darunavir) or substitution of older, cheaper alternatives that are more toxic (e.g., stavudine).SummaryThere is increasing use of CEA to evaluate decisions regarding HIV treatment in order to buy the most health' with limited resources. Expansion of ART access provides substantial clinical and preventive benefit and offers favorable cost-effectiveness. Intensive laboratory monitoring may not be the highest priority in settings in which resources are constrained. Further work on the economic impact, clinical effectiveness, and feasibility of ART treatment for all (e.g., no CD4(+) cell initiation criteria) is needed.