Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
J Int AIDS Soc. 2020 Jun;23 Suppl 1(Suppl 1):e25507. doi: 10.1002/jia2.25507.
Despite growing enthusiasm for integrating treatment of non-communicable diseases (NCDs) into human immunodeficiency virus (HIV) care and treatment services in sub-Saharan Africa, there is little evidence on the potential health and financial consequences of such integration. We aim to study the cost-effectiveness of basic NCD-HIV integration in a Ugandan setting.
We developed an epidemiologic-cost model to analyze, from the provider perspective, the cost-effectiveness of integrating hypertension, diabetes mellitus (DM) and high cholesterol screening and treatment for people living with HIV (PLWH) receiving antiretroviral therapy (ART) in Uganda. We utilized cardiovascular disease (CVD) risk estimations drawing from the previously established Globorisk model and systematic reviews; HIV and NCD risk factor prevalence from the World Health Organization's STEPwise approach to Surveillance survey and global databases; and cost data from national drug price lists, expert consultation and the literature. Averted CVD cases and corresponding disability-adjusted life years were estimated over 10 subsequent years along with incremental cost-effectiveness of the integration.
Integrating services for hypertension, DM, and high cholesterol among ART patients in Uganda was associated with a mean decrease of the 10-year risk of a CVD event: from 8.2 to 6.6% in older PLWH women (absolute risk reduction of 1.6%), and from 10.7 to 9.5% in older PLWH men (absolute risk reduction of 1.2%), respectively. Integration would yield estimated net costs between $1,400 and $3,250 per disability-adjusted life year averted among older ART patients.
Providing services for hypertension, DM and high cholesterol for Ugandan ART patients would reduce the overall CVD risk among these patients; it would amount to about 2.4% of national HIV/AIDS expenditure, and would present a cost-effectiveness comparable to other standalone interventions to address NCDs in low- and middle-income country settings.
尽管在撒哈拉以南非洲地区，人们对将非传染性疾病（NCDs）的治疗纳入人类免疫缺陷病毒（HIV）护理和治疗服务中越来越感兴趣，但关于这种整合的潜在健康和经济后果的证据却很少。我们旨在研究乌干达基本的 NCD-HIV 整合的成本效益。
我们从提供者的角度开发了一种流行病学成本模型，来分析在乌干达将高血压、糖尿病（DM）和高胆固醇筛查和治疗纳入接受抗逆转录病毒疗法（ART）的艾滋病毒感染者（PLWH）的基本 NCD-HIV 整合的成本效益。我们利用心血管疾病（CVD）风险估计，这些风险估计来自先前建立的 Globorisk 模型和系统评价；利用世界卫生组织的 STEPwise 监测方法和全球数据库中的 HIV 和 NCD 风险因素流行率；以及国家药品价格清单、专家咨询和文献中的成本数据。在随后的 10 年中，估计了预防 CVD 病例和相应的伤残调整生命年，并评估了整合的增量成本效益。
在乌干达，为接受抗逆转录病毒治疗的患者整合高血压、DM 和高胆固醇治疗服务与降低 CVD 事件的 10 年风险相关：老年 PLWH 女性从 8.2%降至 6.6%（绝对风险降低 1.6%），老年 PLWH 男性从 10.7%降至 9.5%（绝对风险降低 1.2%）。整合服务估计将为老年接受抗逆转录病毒治疗的患者每避免 1 个伤残调整生命年带来 1400 至 3250 美元的净成本。
为乌干达接受抗逆转录病毒治疗的患者提供高血压、DM 和高胆固醇治疗服务将降低这些患者的总体 CVD 风险；这将占国家 HIV/AIDS 支出的 2.4%左右，并且与其他针对中低收入国家 NCD 的单一干预措施具有相当的成本效益。
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