Cost-effectiveness of preventing loss to follow-up in HIV treatment programs: A Côte d'Ivoire appraisal

Elena Losina, Hapsatou Touré, Lauren M. Uhler, Xavier Anglaret, A. David Paltiel, Eric Balestre, Rochelle P. Walensky, Eugène Messou, Milton C. Weinstein, François Dabis, Kenneth A. Freedberg, Melissa Bender, John Chiosi, Jennifer Chu, Sarah Chung, Andrea Ciaranello, Mariam O. Fofana, Heather E. Hsu, Zhigang Lu, Bethany MorrisBrandon Morris, Erin Rhode, Caroline Sloan, Callie A. Scott, Lauren Uhler, Kara Cotich, Sue J. Goldie, April D. Kimmel, Marc Lipsitch, Chara Rydzak, George R. Seage, Yazdan Yazdanpanah, Roger Salamon, Christine Danel, Thérèse N'Dri-Yoman, Raoul Moh, Eric Ouattara, Siaka Touré, Catherine Seyler, Nagalingeswaran Kumarasamy, A. K. Ganesh, Robin Wood, Glenda Gray, James McIntyre, Neil A. Martinson, Lerato Mohapi, Timothy Flanigan, Kenneth Mayer

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Background: Data from HIV treatment programs in resource-limited settings show extensive rates of loss to follow-up (LTFU) ranging from 5% to 40% within 6 mo of antiretroviral therapy (ART) initiation. Our objective was to project the clinical impact and cost-effectiveness of interventions to prevent LTFU from HIV care in West Africa. Methods and Findings: We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) International model to project the clinical benefits and cost-effectiveness of LTFU-prevention programs from a payer perspective. These programs include components such as eliminating ART co-payments, eliminating charges to patients for opportunistic infection-related drugs, improving personnel training, and providing meals and reimbursing for transportation for participants. The efficacies and costs of these interventions were extensively varied in sensitivity analyses. We used World Health Organization criteria of <3x gross domestic product per capita (3x GDP per capita = US$2,823 for Côte d'Ivoire) as a plausible threshold for "cost-effectiveness." The main results are based on a reported 18% 1-y LTFU rate. With full retention in care, projected per-person discounted life expectancy starting from age 37 y was 144.7 mo (12.1 y). Survival losses from LTFU within 1 y of ART initiation ranged from 73.9 to 80.7 mo. The intervention costing US$22/person/year (e.g., eliminating ART co-payment) would be cost-effective with an efficacy of at least 12%. An intervention costing US$77/person/year (inclusive of all the components described above) would be cost-effective with an efficacy of at least 41%. Conclusions: Interventions that prevent LTFU in resource-limited settings would substantially improve survival and would be cost-effective by international criteria with efficacy of at least 12%-41%, depending on the cost of intervention, based on a reported 18% cumulative incidence of LTFU at 1 y after ART initiation. The commitment to start ART and treat HIV in these settings should include interventions to prevent LTFU.

Original languageEnglish (US)
Article numbere1000173
JournalPLoS Medicine
Volume6
Issue number10
DOIs
StatePublished - Oct 1 2009
Externally publishedYes

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Cost-Benefit Analysis
HIV
Costs and Cost Analysis
Therapeutics
Gross Domestic Product
Aftercare
Western Africa
Survival
Opportunistic Infections
Life Expectancy
Meals
Acquired Immunodeficiency Syndrome
Incidence
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Losina, E., Touré, H., Uhler, L. M., Anglaret, X., Paltiel, A. D., Balestre, E., ... Mayer, K. (2009). Cost-effectiveness of preventing loss to follow-up in HIV treatment programs: A Côte d'Ivoire appraisal. PLoS Medicine, 6(10), [e1000173]. https://doi.org/10.1371/journal.pmed.1000173

Cost-effectiveness of preventing loss to follow-up in HIV treatment programs : A Côte d'Ivoire appraisal. / Losina, Elena; Touré, Hapsatou; Uhler, Lauren M.; Anglaret, Xavier; Paltiel, A. David; Balestre, Eric; Walensky, Rochelle P.; Messou, Eugène; Weinstein, Milton C.; Dabis, François; Freedberg, Kenneth A.; Bender, Melissa; Chiosi, John; Chu, Jennifer; Chung, Sarah; Ciaranello, Andrea; Fofana, Mariam O.; Hsu, Heather E.; Lu, Zhigang; Morris, Bethany; Morris, Brandon; Rhode, Erin; Sloan, Caroline; Scott, Callie A.; Uhler, Lauren; Cotich, Kara; Goldie, Sue J.; Kimmel, April D.; Lipsitch, Marc; Rydzak, Chara; Seage, George R.; Yazdanpanah, Yazdan; Salamon, Roger; Danel, Christine; N'Dri-Yoman, Thérèse; Moh, Raoul; Ouattara, Eric; Touré, Siaka; Seyler, Catherine; Kumarasamy, Nagalingeswaran; Ganesh, A. K.; Wood, Robin; Gray, Glenda; McIntyre, James; Martinson, Neil A.; Mohapi, Lerato; Flanigan, Timothy; Mayer, Kenneth.

In: PLoS Medicine, Vol. 6, No. 10, e1000173, 01.10.2009.

Research output: Contribution to journalArticle

Losina, E, Touré, H, Uhler, LM, Anglaret, X, Paltiel, AD, Balestre, E, Walensky, RP, Messou, E, Weinstein, MC, Dabis, F, Freedberg, KA, Bender, M, Chiosi, J, Chu, J, Chung, S, Ciaranello, A, Fofana, MO, Hsu, HE, Lu, Z, Morris, B, Morris, B, Rhode, E, Sloan, C, Scott, CA, Uhler, L, Cotich, K, Goldie, SJ, Kimmel, AD, Lipsitch, M, Rydzak, C, Seage, GR, Yazdanpanah, Y, Salamon, R, Danel, C, N'Dri-Yoman, T, Moh, R, Ouattara, E, Touré, S, Seyler, C, Kumarasamy, N, Ganesh, AK, Wood, R, Gray, G, McIntyre, J, Martinson, NA, Mohapi, L, Flanigan, T & Mayer, K 2009, 'Cost-effectiveness of preventing loss to follow-up in HIV treatment programs: A Côte d'Ivoire appraisal', PLoS Medicine, vol. 6, no. 10, e1000173. https://doi.org/10.1371/journal.pmed.1000173
Losina, Elena ; Touré, Hapsatou ; Uhler, Lauren M. ; Anglaret, Xavier ; Paltiel, A. David ; Balestre, Eric ; Walensky, Rochelle P. ; Messou, Eugène ; Weinstein, Milton C. ; Dabis, François ; Freedberg, Kenneth A. ; Bender, Melissa ; Chiosi, John ; Chu, Jennifer ; Chung, Sarah ; Ciaranello, Andrea ; Fofana, Mariam O. ; Hsu, Heather E. ; Lu, Zhigang ; Morris, Bethany ; Morris, Brandon ; Rhode, Erin ; Sloan, Caroline ; Scott, Callie A. ; Uhler, Lauren ; Cotich, Kara ; Goldie, Sue J. ; Kimmel, April D. ; Lipsitch, Marc ; Rydzak, Chara ; Seage, George R. ; Yazdanpanah, Yazdan ; Salamon, Roger ; Danel, Christine ; N'Dri-Yoman, Thérèse ; Moh, Raoul ; Ouattara, Eric ; Touré, Siaka ; Seyler, Catherine ; Kumarasamy, Nagalingeswaran ; Ganesh, A. K. ; Wood, Robin ; Gray, Glenda ; McIntyre, James ; Martinson, Neil A. ; Mohapi, Lerato ; Flanigan, Timothy ; Mayer, Kenneth. / Cost-effectiveness of preventing loss to follow-up in HIV treatment programs : A Côte d'Ivoire appraisal. In: PLoS Medicine. 2009 ; Vol. 6, No. 10.
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abstract = "Background: Data from HIV treatment programs in resource-limited settings show extensive rates of loss to follow-up (LTFU) ranging from 5{\%} to 40{\%} within 6 mo of antiretroviral therapy (ART) initiation. Our objective was to project the clinical impact and cost-effectiveness of interventions to prevent LTFU from HIV care in West Africa. Methods and Findings: We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) International model to project the clinical benefits and cost-effectiveness of LTFU-prevention programs from a payer perspective. These programs include components such as eliminating ART co-payments, eliminating charges to patients for opportunistic infection-related drugs, improving personnel training, and providing meals and reimbursing for transportation for participants. The efficacies and costs of these interventions were extensively varied in sensitivity analyses. We used World Health Organization criteria of <3x gross domestic product per capita (3x GDP per capita = US$2,823 for C{\^o}te d'Ivoire) as a plausible threshold for {"}cost-effectiveness.{"} The main results are based on a reported 18{\%} 1-y LTFU rate. With full retention in care, projected per-person discounted life expectancy starting from age 37 y was 144.7 mo (12.1 y). Survival losses from LTFU within 1 y of ART initiation ranged from 73.9 to 80.7 mo. The intervention costing US$22/person/year (e.g., eliminating ART co-payment) would be cost-effective with an efficacy of at least 12{\%}. An intervention costing US$77/person/year (inclusive of all the components described above) would be cost-effective with an efficacy of at least 41{\%}. Conclusions: Interventions that prevent LTFU in resource-limited settings would substantially improve survival and would be cost-effective by international criteria with efficacy of at least 12{\%}-41{\%}, depending on the cost of intervention, based on a reported 18{\%} cumulative incidence of LTFU at 1 y after ART initiation. The commitment to start ART and treat HIV in these settings should include interventions to prevent LTFU.",
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T1 - Cost-effectiveness of preventing loss to follow-up in HIV treatment programs

T2 - A Côte d'Ivoire appraisal

AU - Losina, Elena

AU - Touré, Hapsatou

AU - Uhler, Lauren M.

AU - Anglaret, Xavier

AU - Paltiel, A. David

AU - Balestre, Eric

AU - Walensky, Rochelle P.

AU - Messou, Eugène

AU - Weinstein, Milton C.

AU - Dabis, François

AU - Freedberg, Kenneth A.

AU - Bender, Melissa

AU - Chiosi, John

AU - Chu, Jennifer

AU - Chung, Sarah

AU - Ciaranello, Andrea

AU - Fofana, Mariam O.

AU - Hsu, Heather E.

AU - Lu, Zhigang

AU - Morris, Bethany

AU - Morris, Brandon

AU - Rhode, Erin

AU - Sloan, Caroline

AU - Scott, Callie A.

AU - Uhler, Lauren

AU - Cotich, Kara

AU - Goldie, Sue J.

AU - Kimmel, April D.

AU - Lipsitch, Marc

AU - Rydzak, Chara

AU - Seage, George R.

AU - Yazdanpanah, Yazdan

AU - Salamon, Roger

AU - Danel, Christine

AU - N'Dri-Yoman, Thérèse

AU - Moh, Raoul

AU - Ouattara, Eric

AU - Touré, Siaka

AU - Seyler, Catherine

AU - Kumarasamy, Nagalingeswaran

AU - Ganesh, A. K.

AU - Wood, Robin

AU - Gray, Glenda

AU - McIntyre, James

AU - Martinson, Neil A.

AU - Mohapi, Lerato

AU - Flanigan, Timothy

AU - Mayer, Kenneth

PY - 2009/10/1

Y1 - 2009/10/1

N2 - Background: Data from HIV treatment programs in resource-limited settings show extensive rates of loss to follow-up (LTFU) ranging from 5% to 40% within 6 mo of antiretroviral therapy (ART) initiation. Our objective was to project the clinical impact and cost-effectiveness of interventions to prevent LTFU from HIV care in West Africa. Methods and Findings: We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) International model to project the clinical benefits and cost-effectiveness of LTFU-prevention programs from a payer perspective. These programs include components such as eliminating ART co-payments, eliminating charges to patients for opportunistic infection-related drugs, improving personnel training, and providing meals and reimbursing for transportation for participants. The efficacies and costs of these interventions were extensively varied in sensitivity analyses. We used World Health Organization criteria of <3x gross domestic product per capita (3x GDP per capita = US$2,823 for Côte d'Ivoire) as a plausible threshold for "cost-effectiveness." The main results are based on a reported 18% 1-y LTFU rate. With full retention in care, projected per-person discounted life expectancy starting from age 37 y was 144.7 mo (12.1 y). Survival losses from LTFU within 1 y of ART initiation ranged from 73.9 to 80.7 mo. The intervention costing US$22/person/year (e.g., eliminating ART co-payment) would be cost-effective with an efficacy of at least 12%. An intervention costing US$77/person/year (inclusive of all the components described above) would be cost-effective with an efficacy of at least 41%. Conclusions: Interventions that prevent LTFU in resource-limited settings would substantially improve survival and would be cost-effective by international criteria with efficacy of at least 12%-41%, depending on the cost of intervention, based on a reported 18% cumulative incidence of LTFU at 1 y after ART initiation. The commitment to start ART and treat HIV in these settings should include interventions to prevent LTFU.

AB - Background: Data from HIV treatment programs in resource-limited settings show extensive rates of loss to follow-up (LTFU) ranging from 5% to 40% within 6 mo of antiretroviral therapy (ART) initiation. Our objective was to project the clinical impact and cost-effectiveness of interventions to prevent LTFU from HIV care in West Africa. Methods and Findings: We used the Cost-Effectiveness of Preventing AIDS Complications (CEPAC) International model to project the clinical benefits and cost-effectiveness of LTFU-prevention programs from a payer perspective. These programs include components such as eliminating ART co-payments, eliminating charges to patients for opportunistic infection-related drugs, improving personnel training, and providing meals and reimbursing for transportation for participants. The efficacies and costs of these interventions were extensively varied in sensitivity analyses. We used World Health Organization criteria of <3x gross domestic product per capita (3x GDP per capita = US$2,823 for Côte d'Ivoire) as a plausible threshold for "cost-effectiveness." The main results are based on a reported 18% 1-y LTFU rate. With full retention in care, projected per-person discounted life expectancy starting from age 37 y was 144.7 mo (12.1 y). Survival losses from LTFU within 1 y of ART initiation ranged from 73.9 to 80.7 mo. The intervention costing US$22/person/year (e.g., eliminating ART co-payment) would be cost-effective with an efficacy of at least 12%. An intervention costing US$77/person/year (inclusive of all the components described above) would be cost-effective with an efficacy of at least 41%. Conclusions: Interventions that prevent LTFU in resource-limited settings would substantially improve survival and would be cost-effective by international criteria with efficacy of at least 12%-41%, depending on the cost of intervention, based on a reported 18% cumulative incidence of LTFU at 1 y after ART initiation. The commitment to start ART and treat HIV in these settings should include interventions to prevent LTFU.

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