Cost-Effectiveness of Care and Treatment for HIV/AIDS | | Cost-effectiveness (2001 US$/DALY) |
| Intervention | Source | Before or when initiating antiretroviral therapy | Failed or no antiretroviral therapy |
| HIV testing and diagnosis |
| Confirmatory ELISA, Western blot | No cost-effectiveness studies found in developing countries | — | — |
| Palliative care |
| Pain alleviation | Chapter 52 | 420/year of pain-free life added | 420/year of pain-free life added |
| Symptom-based care | No cost-effectiveness studies found in developing countries | — | — |
| Nutrition interventions | Chapter 56 | 200-250 for HIV-negative individuals | 200-250 for HIV-negative individuals |
| End-of-life care | No cost-effectiveness studies found in developing countries | — | — |
| Treatment of opportunistic infections, per episode |
| Oral candidias | Modeling estimates based on efficacy trials reported from HIVInsite (CHI, 2005) and drug costs (UNICEF and others 2004) | 0.5-157 | 1-394 |
| Esophageal candidiasis | | 0.4-55 | 1-165 |
| Histoplasmosis | | 12-77 | 81-539 |
| Kaposi's sarcoma | | 6,236-63,700 | 12,460-127,400 |
| Cryptococcal meningitis | | 3-86 | 21-546 |
| Penicilliosis | | 11-72 | 76-483 |
| Mycobacterium avium complex | | 31-51 | 87-320 |
| Cytomegalovirus | | 586-995 | 4,875-5,120 |
| PCP | | 0.4-5 | 3-35 |
| Toxoplasmosis | | 5-44 | 31-291 |
| Herpes simplex virus | | 3-32 | 7-80 |
| Tuberculosis | Chapter 16 | 200-370 | 50-450 |
| South Africa (Floyd, Wilkinson, and Gilks 1997); Malawi, Mozambique, Tanzania (Murray and others 1991); Uganda (Saunderson 1995) | Short-course ambulatory: 2-16SFTRETShort-course hospital: 3-8SFTRETCommunity-based directly observed therapy: 14-22 | Short-course ambulatory: 2-16SFTRETShort-course hospital: 3-8SFTRETCommunity-based directly observed therapy: 14-22 |
| Opportunistic infection prophylaxis |
| PCP | Modeling estimates based on efficacy trials reported from HIVInsite (CHI, 2005) and drug costs: (UNICEF and others 2004) | 29-1487 | 590-29,817 |
| Toxoplasmosis | | | 14-412 | 252-8,265 | |
| Mycobacterium avium complex | | | 786-3,604 | 2,247-18,020 | |
| Cytomegalovirus | | | 151,855-972,955 | 976,209-4.5 million | |
| Tuberculosis preventive therapy | Uganda (Bell, Rose, and Sacks 1999); Chapter 16 | 15-300 (Isoniazid, Rifampicin plus pyrazinamide, Isoniazid plus rifampicin) | 15-300 (Isoniazid, Rifampicin plus pyrazinamide, Isoniazid plus rifampicin) |
| Early detection and screening for opportunistic infections |
| HPV screening and treatment | South Africa (Goldie and others 2001) | Direct visual inspection using acetic acid: < 4/years of life saved | Direct visual inspection using acetic acid: < 4/years of life saved |
| Antiretroviral therapy |
| First-line antiretroviral therapy | Sub-Saharan Africa (Marseille, Hofmann, and Kahn 2002) | 350 | 350 |
| Second-line (and subsequent) antiretroviral therapy | India (Over and others 2004) | 492/patient yeara | 492/patient yeara |
| No cost-effectiveness studies found in developing countries | — | — |
| Adherence interventions | No cost-effectiveness studies found in developing countries | — | — |
| Monitoring response to antiretroviral therapy | No cost-effectiveness studies found in developing countries | — | — |
Source: Authors.
— = not available.
a. Antiretroviral therapy for the poorest HIV positive adults. The estimates include the cost of drugs, clinic visits, and laboratory tests for physician monitoring of treatment and assumes 50 percent condom use in the general population.
