COST-EFFECTIVENESS ANALYSIS OF EARLY ZIDOVUDINE TREATMENT OF HIV-INFECTED PATIENTS

Objective-To compare cost effectiveness of early and later treatment w ith zidovudine for patients infected with HIV. Design-Markov chain ana lysis of cost effectiveness based on results of use of health care and efficacy from a trial of zidovudine treatment. Setting-Seven Veterans Affairs medical centres in the United States. Subjects-338 patients w ith symptomatic HIV infection and a lymphocyte count of 200 x 10(6) to 500 x 10(6) CD4 cells/l. Interventions-Zidovudine 1500 mg/day started either at recruitment to the trial or when CD4 cell count fell below 200 x 10(6)/l. Main outcome measures-Health care costs and rates of di sease progression between six clinical states of HIV infection. Result s-Patients given early treatment with zidovudine remained without AIDS for an extra two months at a cost of $10 750 for each extra month wit hout AIDS (at 1991 costs). Cost effectiveness ratio was most sensitive to the cost of zidovudine and to the quality of life of patients rece iving early treatment. At treatment of 500 mg/day the cost effectivene ss ratio for early treatment was $5432 for each extra month without AI DS. Patients given early treatment experienced more side effects, and if their quality of life was devalued by 8% compared with patients tre ated later the two treatments were equivalent in terms of quality adju sted months of life without AIDS. Conclusions-Early treatment with zid ovudine is expensive and is very sensitive to the cost of zidovudine a nd to potential reductions in quality of life of patients who experien ce side effects. Doctors should reconsider early treatment with zidovu dine for patients who experience side effects that substantially compr omise their quality of life.