Early Initiation of Highly Active Antiretroviral Therapies for Aids: Dynamic choice with Endogenous and Exogenous Learning

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(1)2005s-34. Early Initiation of Highly Active Antiretroviral Therapies for Aids: Dynamic Choice with Endogenous and Exogenous Learning Pierre Lasserre, Jean-Paul Moatti, Antoine Soubeyran. Série Scientifique Scientific Series. Montréal Octobre 2005. © 2005 Pierre Lasserre, Jean-Paul Moatti, Antoine Soubeyran. Tous droits réservés. All rights reserved. Reproduction partielle permise avec citation du document source, incluant la notice ©. Short sections may be quoted without explicit permission, if full credit, including © notice, is given to the source..

(2) CIRANO Le CIRANO est un organisme sans but lucratif constitué en vertu de la Loi des compagnies du Québec. Le financement de son infrastructure et de ses activités de recherche provient des cotisations de ses organisations-membres, d’une subvention d’infrastructure du Ministère du Développement économique et régional et de la Recherche, de même que des subventions et mandats obtenus par ses équipes de recherche. CIRANO is a private non-profit organization incorporated under the Québec Companies Act. Its infrastructure and research activities are funded through fees paid by member organizations, an infrastructure grant from the Ministère du Développement économique et régional et de la Recherche, and grants and research mandates obtained by its research teams. Les organisations-partenaires / The Partner Organizations PARTENAIRE MAJEUR . Ministère du Développement économique, de l’Innovation et de l’Exportation PARTENAIRES . Alcan inc. . Banque du Canada . Banque Laurentienne du Canada . Banque Nationale du Canada . Banque Royale du Canada . Bell Canada . BMO Groupe financier . Bombardier . Bourse de Montréal . Caisse de dépôt et placement du Québec . Fédération des caisses Desjardins du Québec . GazMétro . Hydro-Québec . Industrie Canada . Ministère des Finances du Québec . Pratt & Whitney Canada . Raymond Chabot Grant Thornton . Ville de Montréal . École Polytechnique de Montréal . HEC Montréal . Université Concordia . Université de Montréal . Université du Québec . Université du Québec à Montréal . Université Laval . Université McGill . Université de Sherbrooke ASSOCIÉ À : . Institut de Finance Mathématique de Montréal (IFM2) . Laboratoires universitaires Bell Canada . Réseau de calcul et de modélisation mathématique [RCM2] . Réseau de centres d’excellence MITACS (Les mathématiques des technologies de l’information et des systèmes complexes) Les cahiers de la série scientifique (CS) visent à rendre accessibles des résultats de recherche effectuée au CIRANO afin de susciter échanges et commentaires. Ces cahiers sont écrits dans le style des publications scientifiques. Les idées et les opinions émises sont sous l’unique responsabilité des auteurs et ne représentent pas nécessairement les positions du CIRANO ou de ses partenaires. This paper presents research carried out at CIRANO and aims at encouraging discussion and comment. The observations and viewpoints expressed are the sole responsibility of the authors. They do not necessarily represent positions of CIRANO or its partners.. ISSN 1198-8177.

(3) Early Initiation of Highly Active Antiretroviral Therapies for Aids: Dynamic Choice with Endogenous and * Exogenous Learning Pierre Lasserre†, Jean-Paul Moatti‡, Antoine Soubeyran§ Résumé / Abstract Le bien-fondé d’administrer précocement des traitements antirétroviraux à haute activité (HAART) aux personnes infectées par le VIH reste objet de débats dans le monde, car leurs bienfaits à court terme peuvent compromettre les traitements futurs si se développent des souches résistantes du virus. Par ailleurs retarder le recours aux HAART comporte un coût d’opportunité thérapeutique si la santé du patient se dégrade au point qu’il ne peut plus bénéficier par la suite des traitements encore en cours de développement. Nous formulons un modèle à deux périodes où l’adoption du traitement de première période est irréversible et engage le futur, alors que des informations et connaissances nouvelles, exogènes et endogènes, déterminent les conditions entourant la décision thérapeutique de deuxième période. Paradoxalement, sous des conditions reflétant bien les enjeux du recours aux HAART, il s’avère que l’effet résistance éventuel a d’autant moins de chance d’importer pour la décision optimale, que sa gravité est élevée. Mots clés : décisions thérapeutiques, incertitude, information, irréversibilité, traitement, apprentissage endogène, apprentissage exogène Criteria for initiation of highly active antiretroviral treatments (HAART) in HIV-infected patients remain a matter of debate world-wide because short-term benefits have to be balanced with costs of these therapies, and restrictions placed on future treatment options if resistant viral strains develop. On the other hand, postponing the introduction of HAART may involve a therapeutic opportunity cost if a patient’s health is allowed to deteriorate to such an extent of becoming unable to benefit from new treatments currently under development when they become available. We introduce a two period model where period one treatment adoption is an irreversible act with future, but uncertain, consequences. New information, both endogenous and exogenous, arises over time and shapes the conditions surrounding the second period therapeutic decision. A surprising result is that, under conditions that appear close to those surrounding the HAART debate, the magnitude of the feared resistance effect has no effect on leaves the optimal treatment decision as far as it is high enough. Keywords: therapeutic decisions, uncertainty, information, irreversibility, treatment, endogenous learning, exogenous learning Codes JEL : I18, C61 *. Financial support from the FQRSC funds, CHRS, IFM2 and the CNRS is gratefully acknowledged. We thank Stéphane Méchoulan and the participants to the 3rd Canadian Health Study Group Conference. We also thank two anonymous referees; one of them gave us comments too helpful and insightful to be given credit properly within the paper. Forthcoming, Journal of Health Economics. † Département des sciences économiques, Université du Québec à Montréal, CIRANO, and GREQAM. ‡. Faculté d’économie et gestion, Université de la Méditerranée, GREQAM, and INSERM Research Unit 379. Département des sciences économiques, Université de la Méditerranée, and GREQAM, Route des Milles, 13290 Les Milles, France, tel. : 33 (0) 4 42 93 59 80, e-mail: soubey@univ-aix.fr §.

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