Document Detail

Cost-effectiveness of point-of-care viral load monitoring of antiretroviral therapy in resource-limited settings: mathematical modelling study.
MedLine Citation:
PMID:  23462219     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Monitoring of HIV viral load in patients on combination antiretroviral therapy (ART) is not generally available in resource-limited settings. We examined the cost-effectiveness of qualitative point-of-care viral load tests (POC-VL) in sub-Saharan Africa.
DESIGN: Mathematical model based on longitudinal data from the Gugulethu and Khayelitsha township ART programmes in Cape Town, South Africa.
METHODS: Cohorts of patients on ART monitored by POC-VL, CD4 cell count or clinically were simulated. Scenario A considered the more accurate detection of treatment failure with POC-VL only, and scenario B also considered the effect on HIV transmission. Scenario C further assumed that the risk of virologic failure is halved with POC-VL due to improved adherence. We estimated the change in costs per quality-adjusted life-year gained (incremental cost-effectiveness ratios, ICERs) of POC-VL compared with CD4 and clinical monitoring.
RESULTS: POC-VL tests with detection limits less than 1000 copies/ml increased costs due to unnecessary switches to second-line ART, without improving survival. Assuming POC-VL unit costs between US$5 and US$20 and detection limits between 1000 and 10,000 copies/ml, the ICER of POC-VL was US$4010-US$9230 compared with clinical and US$5960-US$25540 compared with CD4 cell count monitoring. In Scenario B, the corresponding ICERs were US$2450-US$5830 and US$2230-US$10380. In Scenario C, the ICER ranged between US$960 and US$2500 compared with clinical monitoring and between cost-saving and US$2460 compared with CD4 monitoring.
CONCLUSION: The cost-effectiveness of POC-VL for monitoring ART is improved by a higher detection limit, by taking the reduction in new HIV infections into account and assuming that failure of first-line ART is reduced due to targeted adherence counselling.
Janne Estill; Matthias Egger; Nello Blaser; Luisa Salazar Vizcaya; Daniela Garone; Robin Wood; Jennifer Campbell; Timothy B Hallett; Olivia Keiser;
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  AIDS (London, England)     Volume:  27     ISSN:  1473-5571     ISO Abbreviation:  AIDS     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-08-16     Completed Date:  2013-10-31     Revised Date:  2014-06-03    
Medline Journal Info:
Nlm Unique ID:  8710219     Medline TA:  AIDS     Country:  England    
Other Details:
Languages:  eng     Pagination:  1483-92     Citation Subset:  IM; X    
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MeSH Terms
Africa South of the Sahara
Anti-HIV Agents / economics*,  therapeutic use
Cohort Studies
Cost-Benefit Analysis / economics
HIV Infections / drug therapy,  economics*
Models, Theoretical
Patient Compliance
Point-of-Care Systems / economics*
Quality-Adjusted Life Years
Randomized Controlled Trials as Topic
Viral Load / drug effects
Grant Support
5U01-AI069924-05/AI/NIAID NIH HHS; U01 AI069924/AI/NIAID NIH HHS
Reg. No./Substance:
0/Anti-HIV Agents
Comment In:
AIDS. 2013 Jun 1;27(9):1509-11   [PMID:  23759750 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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