The cost-effectiveness of antiretroviral therapy for treating HIV disease in the caribbean

Lindsey L. Wolf*, Paul Ricketts, Kenneth A. Freedberg, Hazel Williams-Roberts, Lisa R. Hirschhorn, Kathleen Allen-Ferdinand, William R. Rodriguez, Nomita Divi, Michael T. Wong, Elena Losina

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


BACKGROUND: Antiretroviral therapy (ART) recently became available in the Organization of Eastern Caribbean States (OECS). Survival benefits and budgetary implications associated with universal access to ART have not been examined in the Caribbean. METHODS: Using a state-transition simulation model of HIV with regional data, we projected survival, cost, and cost-effectiveness of treating an HIV-infected cohort. We examined 1 or 2 ART regimens and cotrimoxazole. In sensitivity analysis, we varied HIV natural history and ART efficacy, cost, and switching criteria. RESULTS: Without treatment, mean survival was 2.30 years (mean baseline CD4 count = 288 cells/μL). One ART regimen with cotrimoxazole when the CD4 count was <350 cells/μL provided an additional 5.86 years of survival benefit compared with no treatment; the incremental cost-effectiveness ratio was $690 per year of life saved (YLS). A second regimen added 1.04 years of survival benefit; the incremental cost-effectiveness ratio was $10,960 per YLS compared with 1 regimen. Results were highly dependent on second-line ART costs. Per-person lifetime costs decreased from $17,020 to $9290 if second-line ART costs decreased to those available internationally, yielding approximately $8 million total savings. CONCLUSIONS: In the OECS, ART is cost-effective by international standards. Reducing second-line ART costs increases cost-effectiveness and affordability. Current funding supports implementing universal access regionally over the next year, but additional funding is required to sustain lifetime care for currently infected persons.

Original languageEnglish (US)
Pages (from-to)463-471
Number of pages9
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number4
StatePublished - Dec 2007


  • Antiretroviral therapy
  • Caribbean
  • Cost-effectiveness
  • Organization of Eastern Caribbean States

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)


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