Abstract | BACKGROUND: METHODS: We assessed whether a significant reduction in malaria risk makes LPV/r-based ART regimens cost-effective compared to NNRTI-based regimens in co-endemic, low-resource settings. We modeled the difference in unit cost per disability adjusted life year (DALY) gained among two theoretical groups of HIV+ children under 5 years old receiving ART in a resource-limited setting co-endemic for malaria. The first group received standard NNRTI-based antiretrovirals, the second group received a standard regimen containing LPV/r. We used recent cohort data for the incidence reduction for malaria. Drug costs were taken from the 2011 Clinton Health Access Initiative Antiretroviral (ARV) ceiling price list. DALYs for HIV and malaria were derived from WHO estimates. RESULTS: Our model suggests a unit cost of US$147 per DALY gained for the LPV/r-based group compared to US$37 per DALY gained for the NNRTI-based group. CONCLUSION: In HIV and malaria co-endemic settings, considerations of PI cost effectiveness incorporating known reductions in malaria mortality suggest a nominal increase in DALYs gained for PIs over NNRTI-based regimens for HIV positive children under five on ART. Our analysis was based on several assumptions due to lack of sound data on malaria and HIV DALY attribution among pediatric populations. Further study in this area is required.
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Authors | Bilaal S Ahmed, B Ryan Phelps, Elan B Reuben, Robert E Ferris |
Journal | Transactions of the Royal Society of Tropical Medicine and Hygiene
(Trans R Soc Trop Med Hyg)
Vol. 108
Issue 1
Pg. 49-54
(Jan 2014)
ISSN: 1878-3503 [Electronic] England |
PMID | 24300443
(Publication Type: Journal Article)
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Chemical References |
- Anti-Retroviral Agents
- HIV Protease Inhibitors
- Lopinavir
- Ritonavir
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Topics |
- Anti-Retroviral Agents
(economics, therapeutic use)
- Child, Preschool
- Cohort Studies
- Coinfection
- Cost-Benefit Analysis
- Drug Therapy, Combination
- Female
- HIV Infections
(complications, drug therapy)
- HIV Protease Inhibitors
(economics, therapeutic use)
- Humans
- Incidence
- Infant
- Lopinavir
(economics, therapeutic use)
- Malaria
(economics, epidemiology, prevention & control)
- Male
- Quality-Adjusted Life Years
- Ritonavir
(economics, therapeutic use)
- Uganda
(epidemiology)
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