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The long-term impact and value of curative therapy for HIV: a modelling analysis
Gregory F Guzauskas1,2, Timothy B Hallett3
1The Comparative Health Outcomes, Policy, and Economics Institute, Department of Pharmacy, University of Washington, Seattle, Washington, USA.
Insights
Curative therapies (CTx) for HIV can significantly improve health outcomes and reduce long-term costs compared to antiretroviral therapy (ART) alone. The value-based price of CTx varies by country, influenced by HIV prevalence, ART coverage, and cure probability.
Area of Science:
- Health Economics
- Infectious Disease Modeling
- HIV/AIDS Research
Background:
- Curative therapies (CTx) are being explored to achieve durable remission of HIV without lifelong antiretroviral therapy (ART).
- Modeling long-term health and economic outcomes of HIV is crucial for evaluating new interventions.
- Understanding country-specific value-based prices (VBPs) for CTx is essential for resource allocation.
Purpose of the Study:
- To model the long-term health and cost outcomes of HIV in various countries.
- To assess the impact of hypothetical future CTx on these outcomes.
- To determine country-specific VBPs for CTx.
Main Methods:
- A decision-analytic model was developed to compare CTx+ART versus ART alone.
- Populations in seven low- and middle-income and five high-income countries were modeled.
- Health outcomes were quantified using disability-adjusted life-years (DALYs), projecting to 2100.
Main Results:
- CTx introduction lowered HIV prevalence, prevented new infections, and reduced AIDS-related deaths and DALYs.
- Base case VBPs for CTx ranged from $5,400 (Kenya) to $812,300 (United States).
- VBP was higher in countries with lower ART coverage, lower HIV incidence/prevalence, and higher CTx cure probability.
Conclusions:
- Results quantify VBPs for future curative HIV therapies across diverse global settings.
- Higher CTx cure probability, durability, and scale-up increase VBP; improved ART coverage may decrease it.
- The modeling framework can estimate CTx cost-effectiveness under various epidemic and therapeutic scenarios.
Introduction:
Curative therapies (CTx) to achieve durable remission of HIV disease without the need for antiretroviral therapy (ART) are currently being explored. Our objective was to model the long-term health and cost outcomes of HIV in various countries, the impact of future CTx on those outcomes and the country-specific value-based prices (VBPs) of CTx.
Methods:
We developed a decision-analytic model to estimate the future health economic impacts of a hypothetical CTx for HIV in countries with pre-existing access to ART (CTx+ART), compared to ART alone. We modelled populations in seven low-and-middle-income countries and five high-income countries, accounting for localized ART and other HIV-related costs, and calibrating variables for HIV epidemiology and ART uptake to reproduce historical HIV outcomes before projecting future outcomes to year 2100. Health was quantified using disability-adjusted life-years (DALYs). Base case, pessimistic and optimistic scenarios were modelled for CTx+ART and ART alone. Based on long-term outcomes and each country's estimated health opportunity cost, we calculated the country-specific VBP of CTx.
Results:
The introduction of a hypothetical CTx lowered HIV prevalence and prevented future infections over time, which increased life-years, reduced the number of individuals on ART, reduced AIDS-related deaths, and ultimately led to fewer DALYs versus ART-alone. Our base case estimates for the VBP of CTx ranged from $5400 (Kenya) up to $812,300 (United States). Within each country, the VBP was driven to be greater primarily by lower ART coverage, lower HIV incidence and prevalence, and higher CTx cure probability. The VBP estimates were found to be greater in countries where HIV prevalence was higher, ART coverage was lower and the health opportunity cost was greater.
Conclusions:
Our results quantify the VBP for future curative CTx that may apply in different countries and under different circumstances. With greater CTx cure probability, durability and scale up, CTx commands a higher VBP, while improvements in ART coverage may mitigate its value. Our framework can be utilized for estimating this cost given a wide range of scenarios related to the attributes of a given CTx as well as various parameters of the HIV epidemic within a given country.
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