@article{fdi:010061860,
  title = {{C}ost-effectiveness of early infant hiv diagnosis of {HIV}-exposed infants and immediate antiretroviral therapy in {HIV}-infected children under 24 months in {T}hailand},
  author = {{C}ollins, {I}. {J}. and {C}airns, {J}. and {N}go-{G}iang-{H}uong, {N}icole and {S}irirungsi, {W}. and {L}eechanachai, {P}. and {L}e {C}oeur, {S}ophie and {S}amleerat, {T}. and {K}amonpakorn, {N}. and {M}ekmullica, {J}. and {J}ourdain, {G}onzague and {L}allemant, {M}arc},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {HIV}-infected infants have high risk of death in the first two years of life if untreated. {WHO} guidelines recommend early infant {HIV} diagnosis ({EID}) of all {HIV}-exposed infants and immediate antiretroviral therapy ({ART}) in {HIV}-infected children under 24-months. {W}e assessed the cost-effectiveness of this strategy in {HIV}-exposed non-breastfed children in {T}hailand. {M}ethods: {A} decision analytic model of {HIV} diagnosis and disease progression compared: {EID} using {DNA} {PCR} with immediate {ART} ({E}arly-{E}arly); or {EID} with deferred {ART} based on immune/clinical criteria ({E}arly-{L}ate); vs. clinical/serology based diagnosis and deferred {ART} ({R}eference). {T}he model was populated with survival and cost data from a {T}hai observational cohort and the literature. {I}ncremental cost-effectiveness ratio per life-year gained ({LYG}) was compared against the {R}eference strategy. {C}osts and outcomes were discounted at 3%. {R}esults: {M}ean discounted life expectancy of {HIV}-infected children increased from 13.3 years in the {R}eference strategy to 14.3 in the {E}arly-{L}ate and 17.8 years in {E}arly-{E}arly strategies. {T}he mean discounted lifetime cost was $17,335, $22,583 and $29,108, respectively. {T}he cost-effectiveness ratio of {E}arly-{L}ate and {E}arly-{E}arly strategies was $5,149 and $2,615 per {LYG}, respectively as compared to the {R}eference strategy. {T}he {E}arly-{E}arly strategy was most cost-effective at approximately half the domestic product per capita per {LYG} ($4,420 in {T}hailand 2011). {T}he results were robust in deterministic and probabilistic sensitivity analyses including varying perinatal transmission rates. {C}onclusion: {I}n {T}hailand, {EID} and immediate {ART} would lead to major survival benefits and is cost-effective. {T}hese findings strongly support the adoption of {WHO} recommendations as routine care.},
  keywords = {{THAILANDE}},
  booktitle = {},
  journal = {{P}los {O}ne},
  volume = {9},
  numero = {3},
  pages = {art. e91004 [10 ]},
  ISSN = {1932-6203},
  year = {2014},
  DOI = {10.1371/journal.pone.0091004},
  URL = {https://www.documentation.ird.fr/hor/fdi:010061860},
}