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Choice of time horizon critical in estimating costs and effects of changes to HIV programmes
BACKGROUND: Uganda changed its antiretroviral therapy guidelines in 2014, increasing the CD4 threshold for antiretroviral therapy initiation from 350 cells/μl to 500 cells/μl. We investigate what effect this change in policy is likely to have on HIV incidence, morbidity, and programme costs, and est...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5955498/ https://www.ncbi.nlm.nih.gov/pubmed/29768457 http://dx.doi.org/10.1371/journal.pone.0196480 |
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author | McCreesh, Nicky Andrianakis, Ioannis Nsubuga, Rebecca N. Strong, Mark Vernon, Ian McKinley, Trevelyan J. Oakley, Jeremy E. Goldstein, Michael Hayes, Richard White, Richard G. |
author_facet | McCreesh, Nicky Andrianakis, Ioannis Nsubuga, Rebecca N. Strong, Mark Vernon, Ian McKinley, Trevelyan J. Oakley, Jeremy E. Goldstein, Michael Hayes, Richard White, Richard G. |
author_sort | McCreesh, Nicky |
collection | PubMed |
description | BACKGROUND: Uganda changed its antiretroviral therapy guidelines in 2014, increasing the CD4 threshold for antiretroviral therapy initiation from 350 cells/μl to 500 cells/μl. We investigate what effect this change in policy is likely to have on HIV incidence, morbidity, and programme costs, and estimate the cost-effectiveness of the change over different time horizons. METHODS: We used a complex individual-based model of HIV transmission and antiretroviral therapy scale-up in Uganda. 100 model fits were generated by fitting the model to 51 demographic, sexual behaviour, and epidemiological calibration targets, varying 96 input parameters, using history matching with model emulation. An additional 19 cost and disability weight parameters were varied during the analysis of the model results. For each model fit, the model was run to 2030, with and without the change in threshold to 500 cells/μl. RESULTS: The change in threshold led to a 9.7% (90% plausible range: 4.3%-15.0%) reduction in incidence in 2030, and averted 278,944 (118,452–502,790) DALYs, at a total cost of $28M (-$142M to +$195M). The cost per disability adjusted life year (DALY) averted fell over time, from $3238 (-$125 to +$29,969) in 2014 to $100 (-$499 to +$785) in 2030. The change in threshold was cost-effective (cost <3×Uganda’s per capita GDP per DALY averted) by 2018, and highly cost-effective (cost <Uganda’s per capita GDP per DALY averted) by 2022, for more than 50% of parameter sets. CONCLUSIONS: Model results suggest that the change in threshold is unlikely to have been cost-effective to date, but is likely to be highly cost-effective in Uganda by 2030. The time horizon needs to be chosen carefully when projecting intervention effects. Large amounts of uncertainty in our results demonstrates the need to comprehensively incorporate uncertainties in model parameterisation. |
format | Online Article Text |
id | pubmed-5955498 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-59554982018-05-25 Choice of time horizon critical in estimating costs and effects of changes to HIV programmes McCreesh, Nicky Andrianakis, Ioannis Nsubuga, Rebecca N. Strong, Mark Vernon, Ian McKinley, Trevelyan J. Oakley, Jeremy E. Goldstein, Michael Hayes, Richard White, Richard G. PLoS One Research Article BACKGROUND: Uganda changed its antiretroviral therapy guidelines in 2014, increasing the CD4 threshold for antiretroviral therapy initiation from 350 cells/μl to 500 cells/μl. We investigate what effect this change in policy is likely to have on HIV incidence, morbidity, and programme costs, and estimate the cost-effectiveness of the change over different time horizons. METHODS: We used a complex individual-based model of HIV transmission and antiretroviral therapy scale-up in Uganda. 100 model fits were generated by fitting the model to 51 demographic, sexual behaviour, and epidemiological calibration targets, varying 96 input parameters, using history matching with model emulation. An additional 19 cost and disability weight parameters were varied during the analysis of the model results. For each model fit, the model was run to 2030, with and without the change in threshold to 500 cells/μl. RESULTS: The change in threshold led to a 9.7% (90% plausible range: 4.3%-15.0%) reduction in incidence in 2030, and averted 278,944 (118,452–502,790) DALYs, at a total cost of $28M (-$142M to +$195M). The cost per disability adjusted life year (DALY) averted fell over time, from $3238 (-$125 to +$29,969) in 2014 to $100 (-$499 to +$785) in 2030. The change in threshold was cost-effective (cost <3×Uganda’s per capita GDP per DALY averted) by 2018, and highly cost-effective (cost <Uganda’s per capita GDP per DALY averted) by 2022, for more than 50% of parameter sets. CONCLUSIONS: Model results suggest that the change in threshold is unlikely to have been cost-effective to date, but is likely to be highly cost-effective in Uganda by 2030. The time horizon needs to be chosen carefully when projecting intervention effects. Large amounts of uncertainty in our results demonstrates the need to comprehensively incorporate uncertainties in model parameterisation. Public Library of Science 2018-05-16 /pmc/articles/PMC5955498/ /pubmed/29768457 http://dx.doi.org/10.1371/journal.pone.0196480 Text en © 2018 McCreesh et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article McCreesh, Nicky Andrianakis, Ioannis Nsubuga, Rebecca N. Strong, Mark Vernon, Ian McKinley, Trevelyan J. Oakley, Jeremy E. Goldstein, Michael Hayes, Richard White, Richard G. Choice of time horizon critical in estimating costs and effects of changes to HIV programmes |
title | Choice of time horizon critical in estimating costs and effects of changes to HIV programmes |
title_full | Choice of time horizon critical in estimating costs and effects of changes to HIV programmes |
title_fullStr | Choice of time horizon critical in estimating costs and effects of changes to HIV programmes |
title_full_unstemmed | Choice of time horizon critical in estimating costs and effects of changes to HIV programmes |
title_short | Choice of time horizon critical in estimating costs and effects of changes to HIV programmes |
title_sort | choice of time horizon critical in estimating costs and effects of changes to hiv programmes |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5955498/ https://www.ncbi.nlm.nih.gov/pubmed/29768457 http://dx.doi.org/10.1371/journal.pone.0196480 |
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