Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Clin Infect Dis. 2010 Jul 1;51(1):85-92. doi: 10.1086/653119.
As the global community evaluates the unprecedented investment in the scale-up of human immunodeficiency virus (HIV) therapy and considers future investments in HIV care, it is crucial to identify those HIV interventions that maximize the benefit realized from each dollar spent. The use of laboratory monitoring assays--CD4 cell count and HIV RNA level--in decisions about when to initiate and switch antiretroviral therapy may offer substantial clinical benefit, but their economic value remains controversial. Cost-effectiveness analysis can be used to evaluate the value for money of strategies for HIV care, including alternative approaches to laboratory monitoring. Five published cost-effectiveness analyses address the question of CD4 cell count and HIV RNA level monitoring for HIV-infected patients in Africa, with differing conclusions. We describe the use of cost-effectiveness analysis in resource-limited settings and review the cost-effectiveness literature with regard to monitoring the CD4 cell count and HIV RNA level in Africa, highlighting some of the most critical issues in this debate.
随着全球社会评估在扩大人类免疫缺陷病毒（HIV）治疗方面前所未有的投资，并考虑未来对 HIV 护理的投资，确定那些使每美元支出实现最大效益的 HIV 干预措施至关重要。在决定何时启动和转换抗逆转录病毒治疗时，使用实验室监测检测——CD4 细胞计数和 HIV RNA 水平——可能会带来显著的临床获益，但它们的经济价值仍存在争议。成本效益分析可用于评估 HIV 护理策略的价值，包括对实验室监测的替代方法。五项已发表的成本效益分析针对非洲 HIV 感染者的 CD4 细胞计数和 HIV RNA 水平监测问题得出了不同的结论。我们描述了在资源有限的环境中使用成本效益分析的方法，并回顾了有关在非洲监测 CD4 细胞计数和 HIV RNA 水平的成本效益文献，突出了这一辩论中一些最关键的问题。
