Cost-effectiveness of alternative strategies for initiating and monitoring highly active antiretroviral therapy in the developing world

J Acquir Immune Defic Syndr. 2007 Sep 1;46(1):91-100. doi: 10.1097/QAI.0b013e3181342564.


Objective: Determine the cost-effectiveness of initiating and monitoring highly active antiretroviral therapy (HAART) in developing countries according to developing world versus developed world guidelines.

Design: Lifetime Markov model incorporating costs, quality of life, survival, and transmission to sexual contacts.

Methods: We evaluated treating patients with HIV in South Africa according to World Health Organization (WHO) "3 by 5" guidelines (treat CD4 counts <or=200 cells/mm or patients with AIDS, and monitor CD4 cell counts every 6 months) versus modified WHO guidelines that incorporate the following key differences from developed world guidelines: treat CD4 counts <or=350 cells/mm or viral loads >100,000 copies/mL, and monitor CD4 cell counts and viral load every 3 months.

Results: Incorporating transmission to partners (excluding indirect costs), treating patients according to developed versus developing world guidelines increased costs by US $11,867 and increased life expectancy by 3.00 quality-adjusted life-years (QALYs), for an incremental cost-effectiveness of $3956 per QALY. Including indirect costs, over the duration of the model, there are net cost savings to the economy of $39.4 billion, with increased direct medical costs of $60.5 billion offset by indirect cost savings of $99.9 billion.

Conclusions: Treating patients with HIV according to developed versus developing world guidelines is highly cost-effective and may result in substantial long-term savings.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-HIV Agents / economics*
  • Anti-HIV Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active / economics*
  • Antiretroviral Therapy, Highly Active / statistics & numerical data*
  • Cost-Benefit Analysis
  • Developing Countries / economics*
  • HIV Infections / economics*
  • HIV Infections / prevention & control*
  • Health Care Costs
  • Humans
  • Markov Chains
  • Models, Economic
  • Monte Carlo Method
  • Practice Guidelines as Topic
  • Sensitivity and Specificity
  • South Africa
  • United States
  • United States Dept. of Health and Human Services
  • World Health Organization


  • Anti-HIV Agents