TY - JOUR
T1 - Why Maximizing Quality-Adjusted Life Years, rather than Reducing HIV Incidence, Must Remain Our Objective in Addressing the HIV/AIDS Epidemic
AU - Nosyk, Bohdan
AU - Min, Jeong Eun
AU - Zang, Xiao
AU - Feaster, Daniel J.
AU - Metsch, Lisa
AU - Marshall, Brandon D.L.
AU - Rio, Carlos Del
AU - Granich, Reuben
AU - Schackman, Bruce R.
AU - Montaner, Julio S.G.
AU - on behalf of the Localized HIV modeling study group, behalf of the Localized HIV modeling study group
N1 - Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the BC Ministry of Health-funded “Seek and treat for optimal prevention of HIV & AIDS” pilot project and a grant from the National Institutes of Health/National Institute on Drug Abuse (R01-DA-041747).
Publisher Copyright:
© The Author(s) 2019.
PY - 2019/1/21
Y1 - 2019/1/21
N2 - With efficacious behavioral, biomedical, and structural interventions available, combination implementation strategies are being implemented to combat HIV/AIDS across settings internationally. However, priority statements from national and international bodies make it unclear whether the objective should be the reduction in HIV incidence or the maximization of health, most commonly measured with quality-adjusted life years (QALYs). Building off a model-based evaluation of HIV care interventions in British Columbia, Canada, we compare the optimal sets of interventions that would be identified using HIV infections averted, and QALYs as the primary outcome in a cost-effectiveness analysis. We found an explicit focus on averting new infections undervalues the health benefits derived from antiretroviral therapy, resulting in suboptimal and potentially harmful funding recommendations.
AB - With efficacious behavioral, biomedical, and structural interventions available, combination implementation strategies are being implemented to combat HIV/AIDS across settings internationally. However, priority statements from national and international bodies make it unclear whether the objective should be the reduction in HIV incidence or the maximization of health, most commonly measured with quality-adjusted life years (QALYs). Building off a model-based evaluation of HIV care interventions in British Columbia, Canada, we compare the optimal sets of interventions that would be identified using HIV infections averted, and QALYs as the primary outcome in a cost-effectiveness analysis. We found an explicit focus on averting new infections undervalues the health benefits derived from antiretroviral therapy, resulting in suboptimal and potentially harmful funding recommendations.
KW - HIV
KW - economic evaluation
KW - economic model
KW - quality-adjusted life years
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U2 - 10.1177/2325958218821962
DO - 10.1177/2325958218821962
M3 - Comment/debate
C2 - 30798657
AN - SCOPUS:85062057163
VL - 18
JO - Journal of the International Association of Providers of AIDS Care
JF - Journal of the International Association of Providers of AIDS Care
SN - 2325-9574
ER -