Monday, October 19, 2009: 1:30 PM
Grand Ballroom, Salon 6 (Renaissance Hollywood Hotel)
Sabina Alistar, MS and Margaret L. Brandeau, PhD, Stanford University, Stanford, CA
Purpose: Ukraine has one of the fastest growing HIV epidemics in the world, with half of infections due to injection drug use. Currently, almost no injection drug users (IDUs) have access to methadone substitution therapy, and only 10% of eligible individuals receive highly active antiretroviral therapy (HAART). Both types of programs are likely to be scaled up in the near future. However, the appropriate allocation of resources between the two interventions is unknown. We estimated the effectiveness and cost effectiveness of strategies for expanding methadone programs (up to 25% of IDUs) and HAART (up to 80% of all eligible patients) in Ukraine.
Method: We developed a dynamic compartmental model of the HIV epidemic in a population of non-IDUs, IDUs who inject opiates, and IDUs on methadone. The parameters for the model were based on data from Ukraine. We considered a population of 1,000,000 individuals aged 15-49 stratified according to HIV status and injection drug use. We analyzed the effects of interventions that focus on expanding methadone, increasing access to HAART, or both. We measured health care costs, quality-adjusted life years (QALYs), HIV prevalence, HIV infections averted, and incremental cost effectiveness.
Result: With no incremental interventions, HIV prevalence reached 71.7% in IDUs and 1.22% in non-IDUs after 20 years. Increasing methadone access to 25% of IDUs was the most cost-effective strategy and generated the lowest final HIV prevalence in both IDUs (49.8%) and the general population (0.7%). This strategy averted 5300 infections and added 35,000 QALYs for a cost of $740/QALY gained. Expanding HAART averted fewer infections, even with 80% coverage: 3700 infections were prevented, adding 57,000 QALYs at a cost of $4,400/QALY gained. Increasing both methadone (to 3.1% of IDUs) and HAART access (to 50% of eligible individuals) averted 3150 infections, adding 44,600 QALYs at a cost of $4,100/QALY gained. Treating a limited number of IDUs (10%) with HAART but offering 80% HAART coverage to eligible non-IDUs averted only 1,680 infections, adding 40,200 QALYs at a cost of $4,800/QALY gained.
Conclusion: Methadone substitution therapy is a highly cost-effective option for addressing the growing HIV epidemic in Ukraine. For programs that focus on expanding HAART, provision of minimal access to methadone significantly improves health benefits. Excluding IDUs from HAART reduces infections averted and increases costs.
Candidate for the Lee B. Lusted Student Prize Competition
