Cost-effectiveness of integrating methadone maintenance and antiretroviral treatment for HIV-positive drug users in Vietnam's injection-driven HIV epidemics☆
Section snippets
Background
Asia and the Pacific has experienced the second highest burden of the HIV epidemic, which is largely driven by drug injection (World Health Organization, 2010). In this region, there are about 3.9 million drug users (DUs) accounting for more than a half of the total DUs in the world (Bergenstrom and Abdul-Quader, 2010). Among Asian countries, Vietnam has a typical course of the regional HIV epidemics, which emerged in drug injecting populations, and then concentrated in high-risk groups (The
Antiretroviral treatment services and scope of analysis
The Vietnam National HIV/AIDS care and treatment guideline, adopt from the WHO (2006), determined the eligibility criteria for antiretroviral therapy (ART) at WHO HIV stages 3 and 4, or a CD4 count less than 250 cells/μl (Ministry of Health, 2009b, World Health Organization, 2006). The management of HIV-positive DUs is not significantly different from that of other patient groups. HIV-positive DUs, eligible for ART, are provided first line regimens including Zidovudine/Stavudine + Lamivudine +
Results
Table 2 presents the average costs and QALYs generated from the model in deterministic and probabilistic analysis. At base-case values of all parameters, the cost-effectiveness ratio of ART, DAART-MMT, and ART–MMT strategies was 1358.9, 1118.0 and 1327.1 (USD/QALY), equivalent to 1.22, 1.00, and 1.19 times GDPpc. Compared to the ART strategy, providing MMT for HIV-positive DUs in either standalone sites or integrated model, such as DAART-MMT, incurred higher costs but significantly better
Discussion
We developed a decision analytical model to evaluate the cost-effectiveness of HIV care and treatment strategies for DUs that involved both MMT and ART services. The results indicated that providing MMT along with ART for HIV-positive DUs is incrementally cost-effective from the perspective of health services providers. In addition, the hypothetical model, which integrates ART with MMT and adapts the DOT, brought about an extra 0.047 QALY – approximately 0.5 times standard deviation of health
Conclusions
In conclusion, providing MMT for HIV-positive DUs during ART is incrementally cost-effective. Moreover, direct observations of health workers for drug taking during patients’ visits are potentially useful HIV/AIDS care and treatment outcomes. The results of this study support the scale-up and integration of MMT services with ART for HIV-positive DUs in Vietnam. In addition, the high level of uncertainty observed in this analysis suggests that interventions on patients’ retention, adherence and
Role of funding source
No funding source declared.
Contributors
BXT, AO, ATD, LTN, PXV, PJ, and SH have been involved in designing the study and writing the manuscript. BXT analyzed the secondary data and developed the economic evaluation model. LTN and SM were the co-principle investigator who designed and implemented the original MMT cohort study. All authors have read and approved the final manuscript for submission.
Conflict of interest
All other authors declare that they have no conflicts of interest.
Acknowledgments
We wish to acknowledge the Vietnam Administration of HIV/AIDS Control (VAAC), Ministry of Health for their approval on secondary data use.
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Supplementary material can be found by accessing the online version of this paper at http://dx.doi.org/.
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These authors contributed equally to this work.