Cost-effectiveness evaluation of rapid initiation of antiretroviral therapy based on decision-tree Markov model

Abstract

To the Editor: Human immunodeficiency virus (HIV) type 1 infection remains a serious and intractable public health problem worldwide. In 2020, there were 37.7 million surviving individuals with HIV infection worldwide and 680,000 HIV-related deaths reported by the Joint United Nations Programme on HIV/acquired immune deficiency syndrome (AIDS) (UNAIDS). [1] To combat the complex HIV epidemic, countries are exploring appropriate antiretroviral therapy (ART) strategies in accordance with actual conditions, striving to ensure that more patients can receive therapy. The initiation time of ART has been constantly adjusted throughout the past decade. The World Health Organization (WHO) proposed the concept of rapid initiation of ART in 2017, explicitly suggesting that HIV-positive individuals start ART within 7 days of diagnosis. [2] Studies have shown that rapid initiation can increase viral suppression and medication adherence [3] and reduce HIV transmission and fatality [4] ; thus, it is more advantageous than the conventional therapeutic strategy and contributes to promote HIV prevention and treatment. We collected clinical and cost data to construct decision tree models for costeffectiveness evaluation of different ART strategies. Our findings will support the rapid initiation of ART in China from the perspective of health economics and serve as a reference for the optimization of medical resource allocation.