Why Maximizing Quality-Adjusted Life Years, rather than Reducing HIV Incidence, Must Remain Our Objective in Addressing the HIV/AIDS Epidemic

• Authors: Bohdan Nosyk, BC Centre for Excellence in HIV/AIDS; Jeong Eun Min, BC Centre for Excellence in HIV/AIDS; Xiao Zang, BC Centre for Excellence in HIV/AIDS; Daniel J Feaster, University of Miami; Lisa Metsch, Columbia University; Brandon D L Marshall, Brown University; Carlos del Rio, Emory University; Reuben Granich, Independent Public Health Consultant; Bruce R Schackman, Weill Cornell Medical College; Julio S G Montaner, University of British Columbia
• Journal Title: Journal of the International Association of Providers of AIDS Care
• Volume: Volume 18
• Publisher: SAGE Publications (UK and US) | 2019-01-01
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1177/2325958218821962
• Subjects: Health Sciences, Epidemiology; Health Sciences, Public Health
• Keywords: HIV; economic evaluation; economic model; quality-adjusted life years

Abstract

With efficacious behavioral, biomedical, and structural interventions available, combination implementation strategies are being implemented to combat HIV/AIDS across settings internationally. However, priority statements from national and international bodies make it unclear whether the objective should be the reduction in HIV incidence or the maximization of health, most commonly measured with quality-adjusted life years (QALYs). Building off a model-based evaluation of HIV care interventions in British Columbia, Canada, we compare the optimal sets of interventions that would be identified using HIV infections averted, and QALYs as the primary outcome in a cost-effectiveness analysis. We found an explicit focus on averting new infections undervalues the health benefits derived from antiretroviral therapy, resulting in suboptimal and potentially harmful funding recommendations.