Cost Effectiveness of Antiviral Treatment with Zalcitabine Plus Zidovudine for AIDS Patients with CD4+ Counts Less Than 300/microliters in 5 European Countries

A cost-effectiveness model was developed on the basis of early clinical trial results from the US reporting sustained CD4+ cell response in patients receiving zalcitabine in addition to zidovudine. This model was then adapted and applied to 5 European countries to assess the comparative cost effectiveness of adding zalcitabine to antiviral treatment for AIDS patients. The countries included in the modelling effort were Switzerland, France, Italy, Germany and the UK. The model used a Markov state-transition process to estimate the rate of acute opportunistic disease episodes, lifetime medical treatment costs, and survival for populations of AIDS patients with baseline CD4+ counts of less than 300/microliters. Physician panels in each country developed standard treatment algorithms and adjusted the epidemiological data to reflect the AIDS profile of each country. Economic consultants provided cost data. Results from this exploratory data analysis show that if CD4+ counts correlate with the incidence of opportunistic disease episodes as expected, the combined use of zalcitabine and zidovudine for a 1-year period should be cost effective.