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Priority Paper Evaluation

Modeling the cost–effectiveness of health programs: HIV testing and early treatment in the USA

    Eduard J Beck

    Health Services Research Unit, Department of Public Health & Policy, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK, and, HIV/GUM Division, Chelsea & Westminster Hospital Trust, 369 Fulham Road, London SW10 9NH, UK.

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    Email the corresponding author at becke@unaids.org

    Published Online:28 Jul 2011https://doi.org/10.2217/fmb.11.63

    Abstract

    Evaluation of: Long EF, Brandeau ML, Owens DK. The cost–effectiveness and population outcomes of expanded HIV screening and antiretroviral treatment in the United States. Ann. Intern. Med. 153(12), 778–789 (2010). The recent results from the NIH HIV Prevention Trials Network (HPTN) 052 trial, confirmed the relationship between plasma viral load and degree of infectivity of people living with HIV (PLHIV); when PLHIV are treated with antiretroviral therapy (ART), their infectivity is significantly reduced. This reiterates the importance of ‘treatment for prevention’, as well as the therapeutic function of ART. This and other studies raise a number of important questions, including when to start ART. Given the substantial number of PLHIV that are unaware that they are infected, should policy-makers set-up specific programs to identify these PLHIV and get them into treatment early? Long et al. tried to answer this question by modeling the cost–effectiveness of an expanded screening and treatment program in the USA but how good was their model, how can modeling exercises assist policy-makers in answering these difficult questions and what are some of the broader implications?

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