A systematic review of literature of cost-effectiveness studies of the HIV treatments between 2010 and 2020

Objective: The HIV management through antiretroviral therapy is a major public health issue. ARTs are one of the key elements to reach the “90-90-90 targets”. The WHO aims to provide guidelines to ensure the expansion of efficient regimens. The purpose of this review is to measure how the international guidelines are in adequation with the different national settings, through the screening of various cost-effectiveness analyses. Method: Only studies using ICERs as primary outcome with detailed QALYs and costs were included in this review. The population covered by each study had to be similar between the countries, we then only included studies about HIV-positive individuals without any other conditions. The international recommendation “2 NNRTI + 1 other class” should be followed with at least one regimen. Results: This review reveals that a major issue remains the cost management of the HIV care pathway. Nowadays people living with HIV have a better life expectancy. Therefore, the problematic related to long-term exposure to ART needs to be further documented. In low- and middle- income countries, care access and fund availability are additional issues. These countries must also deal with the lack of local data and use assumptions or non-national data in their modeling. Globally, the WHO recommended treatments are often the most cost-effective. Conclusion: To support HIV programs and policies, new studies are needed. The collect of representative data will improve the modeling. The international guidelines are an efficient contribution but must be adapted to each national context through local guidelines.