Presentation is loading. Please wait.

Presentation is loading. Please wait.

The Cost-effectiveness of Treatment as Prevention: Analysis of the HPTN 052 Trial Supported by NIAID R01 AI058736 and HPTN 052 Rochelle Walensky, MD, MPH.

Published byDeshaun Braxton Modified over 10 years ago

Similar presentations

Presentation on theme: "The Cost-effectiveness of Treatment as Prevention: Analysis of the HPTN 052 Trial Supported by NIAID R01 AI058736 and HPTN 052 Rochelle Walensky, MD, MPH."— Presentation transcript:

1 The Cost-effectiveness of Treatment as Prevention: Analysis of the HPTN 052 Trial Supported by NIAID R01 AI058736 and HPTN 052 Rochelle Walensky, MD, MPH Eric Ross Nagalingeswaran Kumarasamy, MBBS, PhD Robin Wood, FCM, MMed, DTM&H Farzad Noubary, PhD A. David Paltiel, PhD, MBA Yoriko Nakamura Sheela Godbole, MD Mina Hosseinipour, MD, MPH James Hakim, MD Johnstone Kumwenda, FRCP Joseph Makhema, MB, ChB, FRCP Lisa Mills, MD, MSc Ravindre Panchia, BSc, MBBCh Ian Sanne, MBBCh, FCP, DTM&H Milton Weinstein, PhD Elena Losina, PhD Ken Mayer, MD Beatriz Grinsztejn, MD, PhD Jose Pilotto, MD, PhD Suwat Chariyalertsak, MD, DrPH Breno Santos, MD Ying Chen, PhD Lei Wang, PhD Xin Li, PhD Marybeth McCauley, MPH Theresa Gamble, PhD Susan Eshleman, MD, PhD Estelle Piwowar-Manning, BS MT Leslie Cottle, BA Irving Hoffman, PA, MPH Joe Eron, MD Joel Gallant, MD, MPH Susan Swindells, MD Taha Taha, MBBS, PhD Karin Nielsen-Saines, MD, MPH David Celentano, ScD, MHS Max Essex, DVM, PhD Vanessa Elharrar, MD, PhD David Burns, MD, MPH George R. Seage III, DSc, MPH Myron Cohen, MD Kenneth Freedberg, MD, MSc

2 Cohen et al. NEJM 2011 Early ART compared to delayed ART conferred a 96% relative reduction in linked HIV transmissions among serodiscordant couples

3 Objective Collaboration: HPTN 052/CEPAC-International To project the cost-effectiveness of early compared to delayed ART for treatment and prevention in serodiscordant couples We conducted analyses for two countries, South Africa, and India to assess regional differences in value

4 CEPAC-International Model –Mathematical model of HIV natural history and treatment –Clinical and resource utilization data from South Africa and India –Cohort and ART efficacy parameters from HPTN 052 trial Methods: CEPAC-International Model

5 Projects transmission events from index cases –Allows for transmission between 1° and outside partners –Accounts for 1 st - and 2 nd -order transmissions from the index case –Flexible structure allows input variation in: Duration of partnerships Activity outside primary partnerships Transmission by viral load Methods: Transmission Module in CEPAC

6 1)Delayed ART (CD4 <250/µl) 2)Early ART (at presentation) Evaluate outcomes in: –Clinical benefit, cost and transmissions –5-year and lifetime horizons Methods: Two Strategies

7 ParameterInput Mean CD4 (cells/μL)449 48-wk virologic suppression92% Loss to follow-up rate (/100 py)3.4 Average partners (/mo)1.011 Transmission rate (/100 py)0.103-1.483 Model Input Parameters: Cohort, Treatment, and Transmission

8 South AfricaIndia ART (/mo)13 11 OI treatment300-1,00040-300 Routine care20-20010-30 per capita GDP*8,1001,400 1 WHO Global Price Reporting Mechanism *WHO thresholds: “Very cost-effective”: <1x per capita GDP *“Cost-effective”: <3x per capita GDP Model Input Parameters: Costs (2011 US$)

9 South AfricaIndia ART (/mo)13 11 OI treatment300-1,00040-300 Routine care20-20010-30 per capita GDP*8,1001,400 *WHO thresholds: “Very cost-effective”: <1x per capita GDP “Cost-effective”: <3x per capita GDP Model Input Parameters: Costs (2011 US$)

10 5-year survival Early ART93% Delayed ART84% No ART55% Results: Survival for South Africa

11 Early ART Delayed ART No ART Results: Transmission Rates, 5 yrs, South Africa

12 Results: Cost-effectiveness, 5 yrs, South Africa Life expectancy* (years) Costs (USD 2011) ICER † ($/YLS) Delayed ART4.34,850-- Early ART4.64,830Cost-saving * Of 5.0 possible years † Including projected survival losses and cost increases associated with 1 st - and 2 nd -order transmissions

13 Early ART Delayed ART No ART Results: Transmission Rates, Lifetime, South Africa

14 Early ART Delayed ART No ART Results: Cumulative Transmissions, South Africa

15 Results: Cost-effectiveness, Lifetime, South Africa Life expectancy (years) Costs (USD 2011) ICER † ($/YLS) Delayed ART13.315,970-- Early ART15.216,320530 † Including projected survival losses and cost increases associated with 1 st - and 2 nd -order transmissions per capita GDP for South Africa: $8,100

16 Results: Cost-effectiveness, India Life expectancy (years) Costs (USD 2011) ICER † ($/YLS) 5-year horizon Delayed ART4.4*1,810-- Early ART4.6*2,1701,840 Lifetime horizon Delayed ART14.26,840-- Early ART15.87,840530 * Of 5.0 possible yearsper capita GDP for India: $1,400 † Including projected survival losses and cost increases associated with 1 st - and 2 nd -order transmissions

17 Different Costs of HIV Care 010203040010203040 Years since presentation * “Other care costs” include labs, routine care, OI prophylaxis, and treatment for HIV-related events

18 Sensitivity Analyses Treatment and Cost Initial mean CD4 ART starting criteria Loss to follow-up rates ART efficacy Long-term suppressive durability of ART OI incidence rates OI treatment and routine care costs Transmission Duration of primary relationships Rate of new partner acquisition Acute infection transmissibility Acute infection duration

19 Sensitivity Analyses: Transmission 5-year horizon: early ART greatly reduces transmissions compared to delayed ART Robust to changes in all parameters examined Lifetime horizon: early ART moderately reduces cumulative transmissions compared to delayed ART Sensitive to changes in ART efficacy and long- term durability of suppression

20 Sensitivity Analyses: Cost-effectiveness 5-year horizon: early ART is cost-saving in South Africa and cost-effective in India Sensitive to changes in all treatment- and cost- related parameters: variations made early ART very cost-effective in both settings Lifetime horizon: early ART is very cost-effective in both countries Robust to changes in all parameters examined

21 Limitations Specific to the HPTN 052 trial; not necessarily generalizable to non-trial settings, or to individuals not in regular partnerships Excluded productivity and other non-medical benefits of transmission prevention Transmissions beyond 2 nd -order from the index case excluded; likely have a minimal effect on cost-effectiveness results

22 Conclusions In serodiscordant couples – with ART efficacy and behavior data from HPTN 052 – early ART will prevent transmissions in the short-term In South Africa, over the short term, early ART may be cost-saving Early ART for serodiscordant couples is very cost-effective, regardless of country, ART efficacy, or behavior

23 The Cost-effectiveness of Treatment as Prevention: Analysis of the HPTN 052 Trial Supported by NIAID R01 AI058736 and HPTN 052 Rochelle Walensky, MD, MPH Eric Ross Nagalingeswaran Kumarasamy, MBBS, PhD Robin Wood, FCM, MMed, DTM&H Farzad Noubary, PhD A. David Paltiel, PhD, MBA Yoriko Nakamura Sheela Godbole, MD Mina Hosseinipour, MD, MPH James Hakim, MD Johnstone Kumwenda, FRCP Joseph Makhema, MB, ChB, FRCP Lisa Mills, MD, MSc Ravindre Panchia, BSc, MBBCh Ian Sanne, MBBCh, FCP, DTM&H Milton Weinstein, PhD Elena Losina, PhD Ken Mayer, MD Beatriz Grinsztejn, MD, PhD Jose Pilotto, MD, PhD Suwat Chariyalertsak, MD, DrPH Breno Santos, MD Ying Chen, PhD Lei Wang, PhD Xin Li, PhD Marybeth McCauley, MPH Theresa Gamble, PhD Susan Eshleman, MD, PhD Estelle Piwowar-Manning, BS MT Leslie Cottle, BA Irving Hoffman, PA, MPH Joe Eron, MD Joel Gallant, MD, MPH Susan Swindells, MD Taha Taha, MBBS, PhD Karin Nielsen-Saines, MD, MPH David Celentano, ScD, MHS Max Essex, DVM, PhD Vanessa Elharrar, MD, PhD David Burns, MD, MPH George R. Seage III, DSc, MPH Myron Cohen, MD Kenneth Freedberg, MD, MSc

Download ppt "The Cost-effectiveness of Treatment as Prevention: Analysis of the HPTN 052 Trial Supported by NIAID R01 AI058736 and HPTN 052 Rochelle Walensky, MD, MPH."

Similar presentations

Antiretroviral Therapy: An HIV Prevention Strategy? Wafaa El-Sadr, MD, MPH Columbia University Harlem Hospital New York.

Antiretroviral Therapy: An HIV Prevention Strategy? Wafaa El-Sadr, MD, MPH Columbia University Harlem Hospital New York.
Mobile Versus Clinic-Based HIV Testing Results of the Project Accept RCT IAS 2013 2 July 2013 Kuala Lumpur, Malaysia Co-Chaired: Dianne Rausch, PhD, NIMH.

Mobile Versus Clinic-Based HIV Testing Results of the Project Accept RCT IAS July 2013 Kuala Lumpur, Malaysia Co-Chaired: Dianne Rausch, PhD, NIMH.
Treatment as Prevention (TasP)

Treatment as Prevention (TasP)
Clinical Research at JHP LNM – 02 October 2012. OutlineJHU- Administration Building History Influential studies- ◦ PEPI ◦ 052 Future Prospects.

Clinical Research at JHP LNM – 02 October OutlineJHU- Administration Building History Influential studies- ◦ PEPI ◦ 052 Future Prospects.
Feasibility and acceptability of an antiretroviral treatment as prevention (TasP) intervention in rural South Africa Results from the ANRS 12249 TasP cluster-randomised.

Feasibility and acceptability of an antiretroviral treatment as prevention (TasP) intervention in rural South Africa Results from the ANRS TasP cluster-randomised.
Acceptability of early initiation of antiretrovirals for treatment as prevention among HIV-infected persons in Mochudi, Botswana Andrew Logan, PhD; Rebeca.

Acceptability of early initiation of antiretrovirals for treatment as prevention among HIV-infected persons in Mochudi, Botswana Andrew Logan, PhD; Rebeca.
The projects described were supported by T32 AI007433, R01 AI058736, R01 AI093269 from NIAID, P30 AI060354 from HU CFAR, & NIH Fogarty International Center.

The projects described were supported by T32 AI007433, R01 AI058736, R01 AI from NIAID, P30 AI from HU CFAR, & NIH Fogarty International Center.
Myron S. Cohen, MD Protocol Chair 6 th IAS Conference, Rome, Italy July 18, 2011 HPTN 052.

Myron S. Cohen, MD Protocol Chair 6 th IAS Conference, Rome, Italy July 18, 2011 HPTN 052.
Monica Gandhi MD, MPH Associate Professor and Women’s HIV Clinic provider, HIV/AIDS Division San Francisco General Hospital/ UCSF Safe Poz Love, U.S. Positive.

Monica Gandhi MD, MPH Associate Professor and Women’s HIV Clinic provider, HIV/AIDS Division San Francisco General Hospital/ UCSF Safe Poz Love, U.S. Positive.
Treatment of HIV Stops Transmission : Where DO We Go From Here? Cohen et al Lancet, Nov. 2013 Myron S. Cohen, MD Yergan-Bate Professor Medicine, Microbiology.

Treatment of HIV Stops Transmission : Where DO We Go From Here? Cohen et al Lancet, Nov Myron S. Cohen, MD Yergan-Bate Professor Medicine, Microbiology.
The Clinical and Economic Impact of a Generic First-line Antiretroviral Regimen in the United States Supported by NIAID Rochelle P. Walensky, MD, MPH Paul.

The Clinical and Economic Impact of a Generic First-line Antiretroviral Regimen in the United States Supported by NIAID Rochelle P. Walensky, MD, MPH Paul.
Jason R. Andrews, MD Stephen D. Lawn, MD, DTM&H Corina Rusu, BA, BS Robin Wood, FCP, MMed, DTM&H Farzad Noubary, PhD Melissa A. Bender, MD, MPH Robert.

Jason R. Andrews, MD Stephen D. Lawn, MD, DTM&H Corina Rusu, BA, BS Robin Wood, FCP, MMed, DTM&H Farzad Noubary, PhD Melissa A. Bender, MD, MPH Robert.
Analysis of Genetic Linkage of HIV from Couples Enrolled in the HPTN 052 Trial Susan H. Eshleman, MD/PhD HPTN Network Laboratory Johns Hopkins Univ. School.

Analysis of Genetic Linkage of HIV from Couples Enrolled in the HPTN 052 Trial Susan H. Eshleman, MD/PhD HPTN Network Laboratory Johns Hopkins Univ. School.
Expanded HIV Screening in the US: What Will It Cost, and Who Will Pay? A Budget Impact Analysis Erika G. Martin, PhD MPH Rockefeller College of Public.

Expanded HIV Screening in the US: What Will It Cost, and Who Will Pay? A Budget Impact Analysis Erika G. Martin, PhD MPH Rockefeller College of Public.
HIV Science Update: From Rome to Addis – Biomedical Prevention Elly T Katabira, FRCP Department of Medicine Makerere University College of Health Sciences.

HIV Science Update: From Rome to Addis – Biomedical Prevention Elly T Katabira, FRCP Department of Medicine Makerere University College of Health Sciences.
Routine HIV Screening in Portugal: Clinical Impact and Cost-Effectiveness Yazdan Yazdanpanah, MD Julian Perelman, PhD Joana Alves Kamal Mansinho, MD Madeline.

Routine HIV Screening in Portugal: Clinical Impact and Cost-Effectiveness Yazdan Yazdanpanah, MD Julian Perelman, PhD Joana Alves Kamal Mansinho, MD Madeline.
Use of Antivirals in Prevention Oral and Topical Prophylaxis

Use of Antivirals in Prevention Oral and Topical Prophylaxis
Investments in HIV and AIDS are paying off by reducing incidence and mortality Carlos Avila, MD, ScD. Abt Associates, Washington DC Melbourne 22 July 2014.

Investments in HIV and AIDS are paying off by reducing incidence and mortality Carlos Avila, MD, ScD. Abt Associates, Washington DC Melbourne 22 July 2014.
Clinical Significance of HIV-1 Drug Resistance

Clinical Significance of HIV-1 Drug Resistance
HIV Early Treatment Project Groups 1 and 2 n Among HIV-infected participants in sub-Saharan Africa, does initiation of antiretroviral treatment (ART) at.

HIV Early Treatment Project Groups 1 and 2 n Among HIV-infected participants in sub-Saharan Africa, does initiation of antiretroviral treatment (ART) at.

Similar presentations

Ads by Google