SidaSubSaharaV1, Main, Exploration, bibRecord, 007904

Clinical impact and cost-effectiveness of co-trimoxazole prophylaxis in patients with HIV/AIDS in Côte d'Ivoire : a trial-based analysis

Identifieur interne : 007904 ( Main/Exploration ); précédent : 007903; suivant : 007905

Clinical impact and cost-effectiveness of co-trimoxazole prophylaxis in patients with HIV/AIDS in Côte d'Ivoire : a trial-based analysis

Auteurs : Yazdan Yazdanpanah [France] ; Elena Losina [États-Unis] ; Xavier Anglaret [France, Côte d'Ivoire] ; Sue J. Goldie [États-Unis] ; Rochelle P. Walensky [États-Unis] ; Milton C. Weinstein [États-Unis] ; Siaka Toure [Côte d'Ivoire] ; Heather E. Smith [États-Unis] ; Jonathan E. Kaplan [États-Unis] ; Kenneth A. Freedberg [États-Unis]

Source :

AIDS : (London) [ 0269-9370 ] ; 2005.

RBID : Pascal:05-0414469

Descripteurs français

Pascal (Inist)
- SIDA, Antimicrobien, Analyse coût efficacité, Prévention, Côte d'Ivoire, Homme, Enfant, Afrique subsaharienne, Cotrimoxazole, Chimioprophylaxie, Stade précoce, Infection opportuniste.
Wicri :
- geographic : Côte d'Ivoire.
- topic : Homme, Enfant.

English descriptors

KwdEn :
- AIDS, Antimicrobial agent, Chemoprophylaxis, Child, Cost efficiency analysis, Cotrimoxazole, Early stage, Human, Ivory Coast, Opportunistic infection, Prevention, Sub-Saharan Africa.

Abstract

Background: In 2000, WHO/UNAIDS recommended co-trimoxazole prophylaxis for persons at early stages of HIV infection (WHO stage > 2) in sub-Saharan Africa. Objective: To assess the cost-effectiveness of alternative strategies for initiation of co-trimoxazole in Côte d'lvoire. Design: Cost-effectiveness analysis with an HIV simulation model using clinical and cost data from a randomized trial of co-trimoxazole in HIV-infected adults. Methods: The study included HIV-infected patients in Côte d'lvoire, with median age 33 years. Thirty-four percent were classified as WHO stage 2, 59% as stage 3, and 7% as stage 4. The mean CD4 cell count was 331 x 10⁶ cells/l. The interventions were no prophylaxis, clinical criteria-based co-trimoxazole initiation (early: WHO stage > 2; late: WHO stage ≥3), CD4-based co-trimoxazole initiation (< 500, < 200, < 50 x 10⁶ CD4 cells/I). The outcome measures were life expectancy, lifetime costs, and incremental cost-effectiveness. Results: The most effective strategy, initiation of co-trimoxazole prophylaxis at WHO stage > 2, increased undiscounted life expectancy by 5.2 months, discounted life expectancy by 4.4 months, and lifetime costs by US$ 60, compared with no prophylaxis. Delaying prophylaxis initiation until WHO stage > 3 was less costly and less effective. All CD4-based strategies were dominated. The incremental cost-effectiveness of early versus late co-trimoxazole prophylaxis initiation was US$ 200/year of life gained. Results were stable despite wide variations in plausible assumptions about bacterial resistance and the prophylaxis efficacy on co-trimoxazole-resistant strains. Conclusions: For HIV-infected adults in Côte d'lvoire, co-trimoxazole prophylaxis is reasonably cost-effective and most effective if initiated when WHO stage > 2. Early co-trimoxazole prophylaxis will prevent complications prior to antiretroviral therapy initiation and should be considered an essential component of care for early HIV in sub-Saharan Africa.

Affiliations:

Links toward previous steps (curation, corpus...)

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Le document en format XML

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<author><name sortKey="Toure, Siaka" sort="Toure, Siaka" uniqKey="Toure S" first="Siaka" last="Toure">Siaka Toure</name>
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<series><title level="j" type="main">AIDS : (London)</title>
<title level="j" type="abbreviated">AIDS : (Lond.)</title>
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<title level="j" type="abbreviated">AIDS : (Lond.)</title>
<idno type="ISSN">0269-9370</idno>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>AIDS</term>
<term>Antimicrobial agent</term>
<term>Chemoprophylaxis</term>
<term>Child</term>
<term>Cost efficiency analysis</term>
<term>Cotrimoxazole</term>
<term>Early stage</term>
<term>Human</term>
<term>Ivory Coast</term>
<term>Opportunistic infection</term>
<term>Prevention</term>
<term>Sub-Saharan Africa</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr"><term>SIDA</term>
<term>Antimicrobien</term>
<term>Analyse coût efficacité</term>
<term>Prévention</term>
<term>Côte d'Ivoire</term>
<term>Homme</term>
<term>Enfant</term>
<term>Afrique subsaharienne</term>
<term>Cotrimoxazole</term>
<term>Chimioprophylaxie</term>
<term>Stade précoce</term>
<term>Infection opportuniste</term>
</keywords>
<keywords scheme="Wicri" type="geographic" xml:lang="fr"><term>Côte d'Ivoire</term>
</keywords>
<keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term>
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<front><div type="abstract" xml:lang="en">Background: In 2000, WHO/UNAIDS recommended co-trimoxazole prophylaxis for persons at early stages of HIV infection (WHO stage > 2) in sub-Saharan Africa. Objective: To assess the cost-effectiveness of alternative strategies for initiation of co-trimoxazole in Côte d'lvoire. Design: Cost-effectiveness analysis with an HIV simulation model using clinical and cost data from a randomized trial of co-trimoxazole in HIV-infected adults. Methods: The study included HIV-infected patients in Côte d'lvoire, with median age 33 years. Thirty-four percent were classified as WHO stage 2, 59% as stage 3, and 7% as stage 4. The mean CD4 cell count was 331 x 10<sup>6</sup>
 cells/l. The interventions were no prophylaxis, clinical criteria-based co-trimoxazole initiation (early: WHO stage > 2; late: WHO stage ≥3), CD4-based co-trimoxazole initiation (< 500, < 200, < 50 x 10<sup>6</sup>
 CD4 cells/I). The outcome measures were life expectancy, lifetime costs, and incremental cost-effectiveness. Results: The most effective strategy, initiation of co-trimoxazole prophylaxis at WHO stage > 2, increased undiscounted life expectancy by 5.2 months, discounted life expectancy by 4.4 months, and lifetime costs by US$ 60, compared with no prophylaxis. Delaying prophylaxis initiation until WHO stage > 3 was less costly and less effective. All CD4-based strategies were dominated. The incremental cost-effectiveness of early versus late co-trimoxazole prophylaxis initiation was US$ 200/year of life gained. Results were stable despite wide variations in plausible assumptions about bacterial resistance and the prophylaxis efficacy on co-trimoxazole-resistant strains. Conclusions: For HIV-infected adults in Côte d'lvoire, co-trimoxazole prophylaxis is reasonably cost-effective and most effective if initiated when WHO stage > 2. Early co-trimoxazole prophylaxis will prevent complications prior to antiretroviral therapy initiation and should be considered an essential component of care for early HIV in sub-Saharan Africa.</div>
</front>
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<li>France</li>
<li>États-Unis</li>
</country>
<region><li>Aquitaine</li>
<li>Géorgie (États-Unis)</li>
<li>Hauts-de-France</li>
<li>Massachusetts</li>
<li>Nord-Pas-de-Calais</li>
<li>Nouvelle-Aquitaine</li>
</region>
<settlement><li>Bordeaux</li>
<li>Lille</li>
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	Le SIDA en Afrique subsaharienne (serveur d'exploration)
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Le SIDA en Afrique subsaharienne (serveur d'exploration)

Clinical impact and cost-effectiveness of co-trimoxazole prophylaxis in patients with HIV/AIDS in Côte d'Ivoire : a trial-based analysis

Clinical impact and cost-effectiveness of co-trimoxazole prophylaxis in patients with HIV/AIDS in Côte d'Ivoire : a trial-based analysis

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