Sullivan Patrick S, Copeland Cillian, Jarrett James, Mordi Uche, Kotsopoulos Nikos, Martins Rui, Tookes Hansel E
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Global Market Access Solutions Sàrl, Chemin Rouge 8A, 1803, Chardonne, Switzerland.
Adv Ther. 2025 Sep 12. doi: 10.1007/s12325-025-03356-8.
International guidelines emphasize the need for earlier commencement of antiretroviral therapy (ART) among people with HIV (PWH). Reducing the time between HIV diagnosis and ART initiation can improve health outcomes, reduce healthcare utilization, and reduce HIV transmissions. This study evaluated the clinical and economic benefits associated with increasing uptake of rapid start ART among newly diagnosed PWH.
A state transition disease model was developed in the United States setting to evaluate the benefits from earlier initiation of ART. The base case analysis compared two cohorts of 1000 newly diagnosed PWH: one following current patterns of ART initiation, and a counterfactual cohort where those receiving rapid start ART was doubled. Individuals were classified by different CD4 states at diagnosis and over time with viral suppression rates also being tracked. ART and CD4 state-specific healthcare costs were estimated over a 3-year time horizon. Averted HIV transmissions were calculated and used to estimate lifetime healthcare cost savings while CD4-specific mortality was also calculated. Several scenario analyses explored alternate assumptions related to the time at which PWH started ART after diagnosis.
Doubling the proportion of newly diagnosed PWH receiving rapid start ART averted 7 HIV transmissions and 0.3 deaths per 1000 people, corresponding to numbers needed to treat of 141 and 3502, respectively. This leads to cost savings resulting from reduced healthcare resource use and lifetime cost savings from preventing new HIV transmissions.
Reducing the time between HIV diagnosis and ART initiation can provide clinical and economic benefits by eliminating transmissions that might occur while individuals are viremic but not on treatment. The additional costs of providing ART required for this increase achieve high levels of return when considering the lifetime healthcare cost burden of onward HIV transmissions potentially averted by early ART start.
国际指南强调，艾滋病毒感染者（PWH）需要更早开始抗逆转录病毒治疗（ART）。缩短艾滋病毒诊断与开始ART之间的时间可以改善健康结果、减少医疗保健利用并减少艾滋病毒传播。本研究评估了新诊断的PWH中增加快速启动ART的采用率所带来的临床和经济效益。
在美国背景下建立了一个状态转换疾病模型，以评估更早开始ART的益处。基础病例分析比较了两组各1000名新诊断的PWH：一组遵循当前的ART启动模式，另一组为接受快速启动ART的人数翻倍的反事实队列。个体在诊断时按不同的CD4状态分类，并随时间进行跟踪，同时也跟踪病毒抑制率。在3年的时间范围内估计了ART和特定CD4状态的医疗保健成本。计算了避免的艾滋病毒传播，并用于估计终身医疗保健成本节省，同时还计算了特定CD4的死亡率。几个情景分析探讨了与PWH在诊断后开始ART的时间相关的替代假设。
将新诊断的接受快速启动ART的PWH比例翻倍，每1000人可避免7次艾滋病毒传播和0.3例死亡，相应的治疗所需人数分别为141和3502。这导致因减少医疗资源使用而节省成本，并因预防新的艾滋病毒传播而节省终身成本。
缩短艾滋病毒诊断与开始ART之间的时间可以通过消除个体病毒血症但未接受治疗时可能发生的传播来提供临床和经济效益。考虑到早期开始ART可能避免的艾滋病毒后续传播的终身医疗保健成本负担，增加提供ART所需的额外成本可实现高回报率。
