Journal Article

Cost-Effectiveness of Laboratory Monitoring in Sub-Saharan Africa: A Review of the Current Literature

Rochelle P. Walensky, Andrea L. Ciaranello, Ji-Eun Park, Kenneth A. Freedberg and Kenneth H. Mayer

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 51, issue 1, pages 85-92
Published in print July 2010 | ISSN: 1058-4838
Published online July 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/653119
Cost-Effectiveness of Laboratory Monitoring in Sub-Saharan Africa: A Review of the Current Literature

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As the global community evaluates the unprecedented investment in the scale-up of human immunodeficiency virus (HIV) therapy and considers future investments in HIV care, it is crucial to identify those HIV interventions that maximize the benefit realized from each dollar spent. The use of laboratory monitoring assays—CD4 cell count and HIV RNA level—in decisions about when to initiate and switch antiretroviral therapy may offer substantial clinical benefit, but their economic value remains controversial. Cost-effectiveness analysis can be used to evaluate the value for money of strategies for HIV care, including alternative approaches to laboratory monitoring. Five published cost-effectiveness analyses address the question of CD4 cell count and HIV RNA level monitoring for HIV-infected patients in Africa, with differing conclusions.We describe the use of cost-effectiveness analysis in resource-limited settings and review the cost-effectiveness literature with regard to monitoring the CD4 cell count and HIV RNA level in Africa, highlighting some of the most critical issues in this debate.

Journal Article.  4191 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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