Jpn. J. Infect. Dis., 59 (3), 168-173, 2006

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Original Article

Cost-Effectiveness Analysis of Antiretroviral Drug Treatment and HIV-1 Vaccination in Thailand

Shunsuke Ono*, Takako Kurotaki, Tadashi Nakasone1, Mitsuo Honda1, Jotika Boon-Long2, Pathom Sawanpanyalert2 and Kazuko Kimura

Graduate School of Natural Science and Technology, Kanazawa University, Kanazawa 920-1192; 1AIDS Research Center, National Institute of Infectious Diseases, Tokyo 162-8640; and 2National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Muang Nonthaburi 11000, Thailand

(Received August 11, 2005. Accepted April 13, 2006)

*Corresponding author: Mailing address: New Drug Review Division 1, Pharmaceuticals and Medical Devices Agency, Shin-Kasumigaseki Bldg., 3-3-2 Kasumigaseki, Chiyoda-ku, Tokyo 100-0013, Japan. Tel: +81-3-3506-9448C Fax: +81-3-3506-9450, E-mail:

SUMMARY: The prevalence of adult HIV/AIDS in Thailand is declining due to intense prevention strategies, but it still continues to be a critical health problem with a prevalence of 1.5%. Several HIV vaccine candidates for the prevention of HIV infection or progress to AIDS were examined in clinical trials. We evaluated the cost-effectiveness of a vaccination regimen (rBCG prime-rDIs boost) currently in its pre-clinical phase. The cost-effectiveness of three interventions (vaccination, highly active antiretroviral treatment [HAART], and the combination of the two) through an existing vaccination program was assessed in a Markov model. The disability-adjusted life year (DALY) was the main effectiveness measure. In the base case the efficacy of the vaccine for preventing HIV infection was assumed to be 30%. The cost of the vaccine was estimated on the basis of its predicted production capacities in Thailand. The incremental cost-effectiveness ratios of vaccination, HAART, and the combination were about $US 75, $US 610, and $US 267 per DALY averted compared with the do-nothing strategy in the base case. The HAART-only strategy seemed to be less cost-effective than the other options under the current assumptions. Sensitivity analyses indicated that the new HIV infection rate and the vaccine efficacy could affect the results.

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