Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

12th World AIDS Conference

Abstracts 44246-44250 985

regarding the purchase of drugs for TCT. An economic model describing the
costs and benefits of TCT is proposed. A preliminary application of this model
to Costa Rica did suggest that the economic benefits of TCT can equal or in
some scenarios outweigh the economic costs, revealing benefit to cost ratios of
between 1.0:1.0 and 1.8:1.0.
Conclusions: It is imperative that economic data be collected to better inform
policymakers in developing countries about their decision regarding the purchase
of these drugs. It is recommended that such economic data be collected as
organizations initiate their medical assessments of TCT in developing countries. In addition, in poorer developing countries, it is recommended that other
combinations of antiretrovirals be considered and evaluated.
44246 Cost effectiveness of national investment for prevention
of HIV: Evaluation of Canada's investment using a
simulation modeling approach
Nancy L. Meagher', R.A. Hanvelt2, D.G. Schneider2, T.T. Copley2, S. Marion2.
'University of British Columbia Dept. of Health Care and Epidemiology, 2250
Wesbrook Mall Vancouver, British Columbia; 2British Columbia Centre for
Excellence in HIV/AIDS Vancouver BC, Canada
Background: Cost effectiveness analyses are increasingly being used for policy
and program planning. While the rationale for prevention of HIV is strong due to
the enormous human and economic costs of infection, there is still a need to determine the return on investment in prevention for allocation decisions. Evaluation
of prevention in the spread of HIV is problematic: it implies counting something
that doesn't happen, and it runs the danger of excluding benefits such as the
multiplier effect of averting or delaying infections. This paper seeks to evaluate
prevention in Canada on a macro level through simulation modeling.
Methods: A system dynamics approach to evaluation is taken. Two simulation
models are integrated: one on the epidemiology of the infection in diverse populations, and the other on behaviour change from prevention interventions. The latter
model has investment fueling prevention activity, which is a two stage process.
National, provincial and municipal spending on prevention was considered for the
years 1985-1995. Other data on the impact of prevention was gathered through a
classification of existing evaluations in the literature. Weekly iterations were used
to estimate the period 1970-1999. The simulation was run both with and without
investment dollars, with the difference in cumulative incidence being the number
of cases averted.
Results: Early simulations indicate that approximately 9200 cases of HIV were
averted through prevention investment. With $759 million (1996 Can. $) invested,
this implies that to date $82,500 has been spent for every case averted. The
effect compounds on itself, implying increasing returns to scale for prevention.
Note these are the results from simulation analysis, not from field studies.
Conclusion: With direct medical cost s alone estimated to be approximately
$150,000 (1996 Can. $) for an episode of HIV, national spending of an estimated
$82,500 per case of HIV averted is clearly cost saving. As prevention demonstrates a multiplier effect through avoidance of secondary or tertiary infections,
the total number of cases averted will continue to rise. Cost savings in the case
of prevention of infectious disease is an increasing function of time. This exercise
has used simple cost minimization for comparison. Evidently, moving towards a
more comprehensive analysis that accounts for more than direct medical costs
will add strength to the case for prevention.
44247 Combination therapies including protease inhibitors (PI):
economical impact on opportunistic infection treatment
Marie-Caroline Estadieu1, P.H. Monges', A. Forestier', S. Gensollen',
T. Ravaux2, H. Gallais2, P. Tinon-David'. 'Pharmacy Chu Conception, 147 Bd
Baille 13385 Marseille Cedex 5; 2lnfectious Disease Unit, Marseille, France
Objectives: This retrospective study evaluate the influence of P.I. on opportunistic infections to H.I.V. infected patients by antibiotics, antifungals and antivirals
expenses.
Methods: We analysed comsuptions of antiinfectious by family before the
avenement of P.I. (from Avril 1995 to March 1996) and after (from Avril 1996 to
March 1997): antibiotics, antituberculars, antifungals and antivirals therapy.
Results: The P.I. appeared in April 1996 and there use resulted in a marked
increasing in expenditure for antiretroviral agents (+95%). They represented
20% of antiinfectious therapies in 1996 and 38% in 1997. Comsumption of different drugs one year before and one year after April 1996 are: Betalactams:
30%/Macrolides: 23%/antiinfectious used in staphylococcal infections: 62%
Antituberculars and Clofazimine: 50%/Antivirals on cytomegalovirus (CMV):
-51%/Antifungals: +111 %/Antipneumocystis: -8%.
The introduction of the P.I. has lead a diminution of all antiinfectious expenses
(less 18%). Only antifungals family increased: it's explained by the utilisation
of Ambisome" (Amphotericin B liposomal), expensive antifungal. Use of newer
antiretroviral agent is associated with significant reduction in cost of antiinfectious
used in opportunistic infectious treatment (less 35% without Ambisome'"'). This is
in according to several studies mentionned significant fall of CMV infectious, My
cobacterium avium, esophagial candidiasis and cryptosporidia infectious appear
to be associated with P.I. prescriptions.
Conclusion: So P.I. appear to play a beneficial role in minimizing progression
of opportunistic infections and these important costs (9 235 000 FF) may be offset
by hospitalizations decreasing (2 560 000 FF) and antibiotics costsavings (491
000 FF).

I44248 1 Cost-effectiveness of partner notification and counseling
and testing: A decision analysis
Beena Varghese, T. Peterman. CDC 1600 Clifton Road E46 Atlanta GA 30333,
USA
Background: Studies suggest that both partner notification (PN) and counseling/testing (CT) are effective HIV prevention strategies. However, few cost-effectiveness studies have been done. We evaluated the cost-effectiveness of PN and
CT to no-intervention options in preventing new HIV infections.
Method: Decision trees were developed. Assumptions for CT were: HIV prevalence 2%; return for posttest counseling (PC) (if HIV+ 60%, if HIV-40%); risk
of HIV transmission (no counseling 7%, with counseling 3.5%); risk of acquiring
infection (no counseling 0.34%, with counseling 0.26%). Cost estimates (including
patient time) were: HIV+ patient (no PC $72, with PC $103); HIV-patient (no PC
$20, with PC $33).
For PN the assumptions were: 0.6 partners found and tested per index patient;
HIV prevalence in partners 20%; risk of HIV transmission (as above); risk of
acquiring infection (unnotified partner 4%, notified partner-no counseling 2%, with
counseling 1%). Program cost estimates were: $427 to find and offer testing
to a partner; costs of CT (as above). Medical cost of treating HIV $100,000.
Sensitivity analysis estimated the effect of changing different variables on the
cost-effectiveness ratios. The analysis used societal and provider perspectives.
Results: If implemented in a cohort of 10,000 individuals, we estimate that, CT
prevents seven HIV infections and saves society $420,000. PN for the 200 index
patients screened by CT, prevents 3.4 HIV infections and saves an additional
$276,400. Excluding the cost of treating HIV and the costs of patient time (provider
perspective), the cost per case prevented was $18,353 for PN and $27,143 for
CT. The most sensitive assumptions in our model are HIV prevalence, likelihood
of transmission, and the treatment cost of HIV.
Conclusion: CT has a documented prevention benefit and is cost-effective.
With CT in place, PN can be added to further prevent HIV transmissions. PN is
very cost effective in preventing HIV transmissions.
44249 Sexually transmitted disease (STD) in clients infected
with HIV in Ho Chi Minh City (HCMC), Vietnam: A report
from one hospital-based clinic
Thanh Son Nguyen12, L.T. Le Thuy3, P.C. Kloser', P.K. Correll'. 'UMDNJ/New
Jersey Medical School, Newark, NJ; 2695 Cardinal Hill Lane, Powell, Ohio, USA;
3AIDS Committee of Hochiminh City, Hochiminh City, Vietnam (USA)
Issue: Sexually transmitted diseases have been associated with HIV infection in
the AIDS pandemic. An increase in the numbers of STD infections may signal
an increase in HIV infection. Limited resources do not permit the testing of every
clinic and hospital client in HCMC. A person diagnosed with a STD infection or
with a history of STD infection may be a candidate for HIV testing.
Project: Sexually transmitted diseases were examined in one hospital's STD
clinic in HCMC over the period of 1990 through 1997. Information was recorded
on the occurrence of syphilis, gonorrhea, genital warts, genital herpes and the
category of "other STDs". STD numbers were examined in clients with HIV and
clients without HIV to determine if a trend existed between the two infections.
Results: The health care system in Vietnam is predominately self-pay with
few free or reduced cost screening and treatment programs. The cost of an HIV
test (ELISA) is approximately US$5 and many clients of clinics and hospitals
decline testing due to limited funds. The HIV testing centers, operated by the National AIDS Committee, have not provided anonymous testing, but are currently
considering anonymous testing in an attempt to attract at-risk populations. Over
the eight years that STD data was recorded, approximately 118,211 clients were
seen. The number of clients receiving HIV testing ranged from 9 to 28 percent
over the five years that data was recorded for HIV testing. The data supported
the premise that a similar trend in HIV infection and STD infection exists.
Lessons Learned: STD trends can be used to screen for HIV testing in the
population examined. Clients with previous or recurrent STD infections may be
candidates for HIV testing. Women of childbearing age with a history of STD
infection may want to consider HIV testing prior to becoming pregnant due to disease progression, increased morbidity and the risk of vertical transmission. Free
or reduced-cost, anonymous HIV testing should be made available, especially to
at-risk populations.
44250 |Advances in HIV management: What is real?
Anete Trajman1 2, M.T.C. Belo3, E.G. Teixeira3, L. Selig4, E. Belo Neto6,
N. Spector5, M.M. Castello Branco6. 'Rua Macedo Sorinho 74/203, Humaita
22271-080, Rio de Janeiro-RJ; 2U. Gama Filho, F.T.E. Souza Marques, Faperj,
Rio de Janeiro, RJ; 3U. Gama Filho, FT.E. Souza Marques, SMS-RJ, Rio de
Janeiro, RJ; 4Sec. Est. Saude-RJ, U. Gama Filho, FMT-FESO, Rio de Janeiro,
RJ; 5Universidade Federal Do Rio de Janeiro, Rio de Janeiro, RJ; 6U. Gama
Filho, FT.E. Souza Marques, Rio de Janeiro, RJ, Brazil
Objective: To evaluate the applicability of the recent guidelines for AIDS man
agement in different countries.
Methods: An anonymous questionnaire consisting of 14 questions on diagnostic procedures and on antiretroviral treatment (ART) was sent to all first authors
of the Track B section of the Vancouver Conference on AIDS (maximum of 50 per
continent). We excluded authors who do not provide direct medical care to HIV+
patients.