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Titre du document / Document title

Effectiveness and cost-effectiveness of strategies to expand antiretroviral therapy in St. Petersburg, Russia

Auteur(s) / Author(s)

LONG Elisa F. (1) ; BRANDEAU Margaret L. (1) ; GALVIN Cristina M. (2) ; VINICHENKO Tatyana (2) ; TOLE Swati P. (2) ; SCHWARTZ Adam (2) ; SANDERS Gillian D. (3) ; OWENS Douglas K. (2 4) ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

(1) Department of Management Science and Engineering, Stanford University, Stanford, California, ETATS-UNIS
(2) Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, ETATS-UNIS
(3) Duke Clinical Research Institute, Duke University, Durham, North Carolina, ETATS-UNIS
(4) Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, California, ETATS-UNIS

Résumé / Abstract

Objective: To assess the effectiveness and cost-effectiveness of treating HIV-infected injection drug users (IDUs) and non-IDUs in Russia with highly active antiretroviral therapy HAART. Design and methods: A dynamic HIV epidemic model was developed for a population of IDUs and non-IDUs. The location for the study was St. Petersburg, Russia. The adult population aged 15 to 49 years was subdivided on the basis of injection drug use and HIV status. HIV treatment targeted to IDUs and non-IDUs, and untargeted treatment interventions were considered. Health care costs and quality-adjusted life years (QALYs) experienced in the population were measured, and HIV prevalence, HIV infections averted, and incremental cost-effectiveness ratios of different HAART strategies were calculated. Results: With no incremental HAART programs, HIV prevalence reached 64% among IDUs and 1.7% among non-IDUs after 20 years. If treatment were targeted to IDUs, over 400 00 infections would be prevented (75% among non-IDUs), adding 650 000 QALYs at a cost of US$1501 per QALY gained. If treatment were targeted to non-IDUs, fewer than 10000 infections would be prevented, adding 400000 QALYs at a cost of US$2572 per QALY gained. Untargeted strategies prevented the most infections, adding 950000 QALYs at a cost of US$1827 per QALY gained. Our results were sensitive to HIV transmission parameters. Conclusions: Expanded use of antiretroviral therapy in St. Petersburg, Russia would generate enormous population-wide health benefits and be economically efficient. Exclusively treating non-IDUs provided the least health benefit, and was the least economically efficient. Our findings highlight the urgency of initiating HAART for both IDUs and non-IDUs in Russia.

Revue / Journal Title

AIDS    ISSN  0269-9370 

Source / Source

2006, vol. 20, no17, pp. 2207-2215 [9 page(s) (article)] (40 ref.)

Langue / Language

Anglais

Editeur / Publisher

Lippincott Williams & Wilkins, Hagerstown, MD, ETATS-UNIS  (1987) (Revue)

Mots-clés anglais / English Keywords

Public health

;

Immunopathology

;

Immune deficiency

;

Health economy

;

Vertebrata

;

Pisces

;

Eurasia

;

Infection

;

Viral disease

;

Human

;

Resource allocation

;

Idus idus

;

Russian Federation

;

Treatment

;

Cost efficiency analysis

;

Chemotherapy

;

Antiviral

;

Drug addiction

;

AIDS

;

Mots-clés français / French Keywords

Santé publique

;

Immunopathologie

;

Immunodéficit

;

Economie santé

;

Vertebrata

;

Pisces

;

Eurasie

;

Infection

;

Virose

;

Homme

;

Allocation ressource

;

Idus idus

;

Fédération de Russie

;

Traitement

;

Analyse coût efficacité

;

Chimiothérapie

;

Antiviral

;

Toxicomanie

;

SIDA

;

Mots-clés espagnols / Spanish Keywords

Salud pública

;

Inmunopatología

;

Inmunodeficiencia

;

Economía salud

;

Vertebrata

;

Pisces

;

Eurasia

;

Infección

;

Virosis

;

Hombre

;

Asignación recurso

;

Idus idus

;

Federación de Rusia

;

Tratamiento

;

Análisis costo eficacia

;

Quimioterapia

;

Antiviral

;

Toxicomanía

;

SIDA

;

Mots-clés d'auteur / Author Keywords

Russia

;

H#V

;

AIDS

;

HIV prevention

;

resource allocation

;

injection drug use

;

Localisation / Location

INIST-CNRS, Cote INIST : 22094, 35400015891303.0100

Nº notice refdoc (ud4) : 18287703



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