A Study Comparing Cost-Effectiveness of Combination Therapy for Preventing Opportunistic Infections Among Human Immunodeficiency Virus-Infected Adults on Antiretroviral Therapy.

OBJECTIVES: India is going through an epidemiologic and demographic transition made possible by increased investment in health sector and sustained development. The country has more than 2 million people infected with human immunodeficiency virus (HIV). Information on cost-effectiveness of competing interventions is a useful contributor to decisions concerning allocation and prioritization of healthcare resources. This paper aims to study the cost, health outcomes as measured by disability-adjusted life-years (DALYs), and cost-effectiveness per DALY averted of prophylaxis for tuberculosis, diarrhea, and mouth ulcers in HIV-infected adults.

METHODS: Data were analyzed on 375 HIV-infected persons enrolled at the ART Centre in New Delhi between April 2004 and April 2006. Using estimates of the age of onset of HIV infection, cost of medicines, and antiretroviral regimen followed, we used standard methods to calculate the cost per DALY as a measure of cost-effectiveness. Sensitivity analysis was conducted to determine the robustness of cost-effectiveness results by making reasonable changes in underlying assumptions.

RESULTS: The results revealed that the incremental cost-effectiveness ratio for tuberculosis prophylaxis was ₹4821.48 ($78.86) per DALY averted compared with no prophylaxis, followed by diarrhea (₹8299.08, $135.74) and mouth ulcers (₹20 058.14, $328.07).

CONCLUSIONS: The estimates are less than the per capita gross domestic product of India, indicating that the current treatments are highly cost-effective. This will help policymakers understand the best opportunities to improve population health and help researchers to develop more standardized methods in the area, thus improving quality and comparability across cost per DALY studies.