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@article{Eaton:2014:10.1016/S2214-109X(13)70172-4,
author = {Eaton, JW and Menzies, NA and Stover, J and Cambiano, V and Chindelevitch, L and Cori, A and Hontelez, JAC and Humair, S and Kerr, CC and Klein, DJ and Mishra, S and Mitchell, KM and Nichols, BE and Vickerman, P and Bakker, R and Baernighausen, T and Bershteyn, A and Bloom, DE and Boily, M-C and Chang, ST and Cohen, T and Dodd, PJ and Fraser, C and Gopalappa, C and Lundgren, J and Martin, NK and Mikkelsen, E and Mountain, E and Pham, QD and Pickles, M and Phillips, A and Platt, L and Pretorius, C and Prudden, HJ and Salomon, JA and van, de Vijver DAMC and de, Vlas SJ and Wagner, BG and White, RG and Wilson, DP and Zhang, L and Blandford, J and Meyer-Rath, G and Remme, M and Revill, P and Sangrujee, N and Terris-Prestholt, F and Doherty, M and Shaffer, N and Easterbrook, PJ and Hirnschall, G and Hallett, TB},
doi = {10.1016/S2214-109X(13)70172-4},
journal = {The Lancet Global Health},
pages = {E23--E34},
title = {Health benefits, costs, and cost-effectiveness of earlier eligibility for adult antiretroviral therapy and expanded treatment coverage: a combined analysis of 12 mathematical models},
url = {http://dx.doi.org/10.1016/S2214-109X(13)70172-4},
volume = {2},
year = {2014}
}

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TY  - JOUR
AB  - BackgroundNew WHO guidelines recommend initiation of antiretroviral therapy for HIV-positive adults with CD4 counts of 500 cells per μL or less, a higher threshold than was previously recommended. Country decision makers have to decide whether to further expand eligibility for antiretroviral therapy accordingly. We aimed to assess the potential health benefits, costs, and cost-effectiveness of various eligibility criteria for adult antiretroviral therapy and expanded treatment coverage.MethodsWe used several independent mathematical models in four settings—South Africa (generalised epidemic, moderate antiretroviral therapy coverage), Zambia (generalised epidemic, high antiretroviral therapy coverage), India (concentrated epidemic, moderate antiretroviral therapy coverage), and Vietnam (concentrated epidemic, low antiretroviral therapy coverage)—to assess the potential health benefits, costs, and cost-effectiveness of various eligibility criteria for adult antiretroviral therapy under scenarios of existing and expanded treatment coverage, with results projected over 20 years. Analyses assessed the extension of eligibility to include individuals with CD4 counts of 500 cells per μL or less, or all HIV-positive adults, compared with the previous (2010) recommendation of initiation with CD4 counts of 350 cells per μL or less. We assessed costs from a health-system perspective, and calculated the incremental cost (in US$) per disability-adjusted life-year (DALY) averted to compare competing strategies. Strategies were regarded very cost effective if the cost per DALY averted was less than the country's 2012 per-head gross domestic product (GDP; South Africa: $8040; Zambia: $1425; India: $1489; Vietnam: $1407) and cost effective if the cost per DALY averted was less than three times the per-head GDP.FindingsIn South Africa, the cost per DALY averted of extending eligibility for antiretroviral therapy to adult patients with CD4 counts of 500 cells per &
AU  - Eaton,JW
AU  - Menzies,NA
AU  - Stover,J
AU  - Cambiano,V
AU  - Chindelevitch,L
AU  - Cori,A
AU  - Hontelez,JAC
AU  - Humair,S
AU  - Kerr,CC
AU  - Klein,DJ
AU  - Mishra,S
AU  - Mitchell,KM
AU  - Nichols,BE
AU  - Vickerman,P
AU  - Bakker,R
AU  - Baernighausen,T
AU  - Bershteyn,A
AU  - Bloom,DE
AU  - Boily,M-C
AU  - Chang,ST
AU  - Cohen,T
AU  - Dodd,PJ
AU  - Fraser,C
AU  - Gopalappa,C
AU  - Lundgren,J
AU  - Martin,NK
AU  - Mikkelsen,E
AU  - Mountain,E
AU  - Pham,QD
AU  - Pickles,M
AU  - Phillips,A
AU  - Platt,L
AU  - Pretorius,C
AU  - Prudden,HJ
AU  - Salomon,JA
AU  - van,de Vijver DAMC
AU  - de,Vlas SJ
AU  - Wagner,BG
AU  - White,RG
AU  - Wilson,DP
AU  - Zhang,L
AU  - Blandford,J
AU  - Meyer-Rath,G
AU  - Remme,M
AU  - Revill,P
AU  - Sangrujee,N
AU  - Terris-Prestholt,F
AU  - Doherty,M
AU  - Shaffer,N
AU  - Easterbrook,PJ
AU  - Hirnschall,G
AU  - Hallett,TB
DO  - 10.1016/S2214-109X(13)70172-4
EP  - 34
PY  - 2014///
SN  - 2214-109X
SP  - 23
TI  - Health benefits, costs, and cost-effectiveness of earlier eligibility for adult antiretroviral therapy and expanded treatment coverage: a combined analysis of 12 mathematical models
T2  - The Lancet Global Health
UR  - http://dx.doi.org/10.1016/S2214-109X(13)70172-4
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000336423900015&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70172-4/fulltext#seccestitle10
UR  - http://hdl.handle.net/10044/1/15387
VL  - 2
ER  -

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