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Medical Decision Making
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A Systematic Review of Cost-Utility Analyses in HIV/AIDS: Implications for Public Policy

John Hornberger, MD, MS

The SPHERE Institute/Acumen, LLC, Burlingame, California, Department of Veterans Affairs, Palo Alto, California, Department of Medicine, Stanford University School of Medicine, Stanford, California, jhornberger{at}cedarecon.com

Mark Holodniy, MD, FACP

AIDS Research Center, VA Palo Alto Health Care System, Palo Alto, California, Division of Infectious Diseases & Geographic Medicine, Stanford University, Stanford, California, Veterans Health Administration, Public Health Strategic Health Care Group, Washington, DC

Katherine Robertus, MPH

The SPHERE Institute/Acumen, LLC, Burlingame, California

Michael Winnike, BA

The SPHERE Institute/Acumen, LLC, Burlingame, California

Erin Gibson, MA

The SPHERE Institute/Acumen, LLC, Burlingame, California

Eric Verhulst, BA

The SPHERE Institute/Acumen, LLC, Burlingame, California

Objectives . To determine whether gaps exist in published cost-utility analyses as measured by their coverage of topics addressed in current HIV guidelines from the Department of Health and Human Services (DHHS). Design. A systematic review of US-based cost-effectiveness analyses of HIV/AIDS prevention and management strategies, based on original, published research. Methods . Predefined criteria were used to identify all analyses pertaining to prevention and management of HIV/AIDS; information was collected on type of strategy, patient demographics, study perspective, quality of the study, effectiveness measures, costs, and cost-effectiveness ratios. Results . One hundred and six studies were identified; 62 described strategies for averting new HIV infections, and 44 dealt with managing persons who are HIV positive. The quality of studies was generally high, but gaps were found in all studies. Especially common were omissions in reporting data abstraction methodology and discussions of direction and magnitude of potential biases. Among the 22 most highly rated papers (score of 90 or higher), only 1 was cited in the guidelines, and 3 papers reported on interventions that were superseded by newer approaches. Using a $100,000 threshold, the guidelines usually endorsed interventions found to be cost-effective. Exceptions included recommending postexposure prophylaxis (PEP) for populations in which PEP is unlikely to be cost-effective and not recommending primary resistance testing in treatment-naive persons, although the intervention was reported to have a cost-effectiveness ratio of less than $50,000. Conclusions . Despite an abundant literature on the cost-utility of HIV/AIDS-targeted strategies, guidelines cite relatively few of these papers, and gaps exist regarding assessments of some strategies and special populations.

Key Words: Key words: HIV • economics • cost and cost analyses • cost-utility • public policy.

References

Medical Decision Making, Vol. 27, No. 6, 789-821 (2007)
DOI: 10.1177/0272989X07306112
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This Article
Right arrow Abstract Freely available
Right arrow Free Full Text (Free PDF) Free
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Saved Citations
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Request Reprints
Right arrow Add to My Marked Citations
Citing Articles
Right arrow Citing Articles via Web of Science (1)
Right arrow Citing Articles via Google Scholar
Right arrow Citing Articles via Scopus
Google Scholar
Right arrow Articles by Hornberger, J.
Right arrow Articles by Verhulst, E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Hornberger, J.
Right arrow Articles by Verhulst, E.
Social Bookmarking
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What's this?