The Cost-Effectiveness of Early Access to HIV Services and Starting cART in the UK 1996 – 2008

Aim: To calculate use, cost and cost-effectiveness of people living with HIV (PLHIV) starting routine treatment and care before starting combination antiretroviral therapy (cART) and PLHIV starting first-line 2NRTIs+NNRTI or 2NRTIs+PIboosted, comparing PLHIV with CD4#200 cells/mm3 and CD4.200 cells/mm3. Few studies have calculated the use, cost and costeffectiveness of routine treatment and care before starting cART and starting cART above and below CD4 200 cells/mm3. Methods: Use, costs and cost-effectiveness were calculated for PLHIV in routine pre-cART and starting first-line cART, comparing CD4#200 cells/mm3 with CD4.200 cells/mm3 (2008 UK prices). Results: cART naı̈ve patients CD4#200 cells/mm3 had an annual cost of £6,407 (95%CI £6,382 to £6,425) PPY compared with £2,758 (95%CI £2,752 to £2,761) PPY for those with CD4.200 cells/mm3; cost per life year gained of pre-cART treatment and care for those with CD4.200 cells/mm3 was £1,776 (cost-saving to £2,752). Annual cost for starting 2NRTIs+NNRTI or 2NRTIs+PIboosted with CD4#200 cells/mm3 was £12,812 (95%CI £12,685–£12,937) compared with £10,478 (95%CI £10,376–£10,581) for PLHIV with CD4.200 cells/mm3. Cost per additional life-year gained on first-line therapy for those with CD4.200 cells/mm3 was £4639 (£3,967 to £2,960). Conclusion: PLHIV starting to use HIV services before CD4#200 cells/mm3 is cost-effective and enables them to be monitored so they start cART with a CD4.200 cells/mm3, which results in better outcomes and is cost-effective. However, 25% of PLHIV accessing services continue to present with CD4#200 cells/mm3. This highlights the need to investigate the cost-effectiveness of testing and early treatment programs for key populations in the UK. Citation: Beck EJ, Mandalia S, Sangha R, Sharott P, Youle M, et al. (2011) The Cost-Effectiveness of Early Access to HIV Services and Starting cART in the UK 1996– 2008. PLoS ONE 6(12): e27830. doi:10.1371/journal.pone.0027830 Editor: Roberto F. Speck, University Hospital Zurich, Switzerland Received August 2, 2011; Accepted October 26, 2011; Published December 14, 2011 Copyright: ß 2011 Beck et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: During 2010/2011, the NPMS-HHC was financially supported through a non-restrictive grant from Bristol-Myers Squibb, with no influence on the independence of the Steering Group and its editorial policy. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The NPMS-HHC was financially supported through a non-restrictive grant from Bristol-Myers Squibb. There are no patents, products in development or marketed products to declare. This does not alter the authors’ adherence to all the PLoS ONE policies on sharing data and materials. * E-mail: becke@unaids.org