Combined antiviral treatment in HIV infection. Is it value for money

The routine prescribing of combination antiretroviral therapy appears to have contributed to the fall in HIV-related in-patient admissions mortality and morbidity with a concomitant increase in pharmacy costs. This study estimates the cost effectiveness of combination therapies for HIV disease using local secondary care data and Markov modeling techniques. Cost effectiveness analyses of combination therapies are complicated by the fact that it is necessary to model drug effects years into the future and well ahead of actual clinical experience with many of the drugs particularly protease inhibitors. Assumptions need to be made which are unlikely to hold true such as the survival benefits of combination therapies remaining constant over time. Furthermore it is not known whether long-term effects will reduce the usefulness of the therapies or cause costly side effects.