The cost-effectiveness of monitoring strategies for antiretroviral therapy of HIV infected patients in resource-limited settings: software tool

 

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dc.contributor.author Estill, Janne en_ZA
dc.contributor.author Salazar-Vizcaya, Luisa en_ZA
dc.contributor.author Blaser, Nello en_ZA
dc.contributor.author Egger, Matthias en_ZA
dc.contributor.author Keiser, Olivia en_ZA
dc.date.accessioned 2015-11-16T04:09:33Z
dc.date.available 2015-11-16T04:09:33Z
dc.date.issued 2015 en_ZA
dc.identifier.citation Estill, J., Salazar-Vizcaya, L., Blaser, N., Egger, M., & Keiser, O. (2015). The cost-effectiveness of monitoring strategies for antiretroviral therapy of HIV infected patients in resource-limited settings: software tool. PloS one, 10(3), e0119299. doi:10.1371/journal.pone.0119299 en_ZA
dc.identifier.uri http://hdl.handle.net/11427/14993
dc.identifier.uri http://dx.doi.org/10.1371/journal.pone.0119299
dc.description.abstract BACKGROUND: The cost-effectiveness of routine viral load (VL) monitoring of HIV-infected patients on antiretroviral therapy (ART) depends on various factors that differ between settings and across time. Low-cost point-of-care (POC) tests for VL are in development and may make routine VL monitoring affordable in resource-limited settings. We developed a software tool to study the cost-effectiveness of switching to second-line ART with different monitoring strategies, and focused on POC-VL monitoring. METHODS: We used a mathematical model to simulate cohorts of patients from start of ART until death. We modeled 13 strategies (no 2 nd -line, clinical, CD4 (with or without targeted VL), POC-VL, and laboratory-based VL monitoring, with different frequencies). We included a scenario with identical failure rates across strategies, and one in which routine VL monitoring reduces the risk of failure. We compared lifetime costs and averted disability-adjusted life-years (DALYs). We calculated incremental cost-effectiveness ratios (ICER). We developed an Excel tool to update the results of the model for varying unit costs and cohort characteristics, and conducted several sensitivity analyses varying the input costs. RESULTS: Introducing 2 nd -line ART had an ICER of US$1651-1766/DALY averted. Compared with clinical monitoring, the ICER of CD4 monitoring was US$1896-US$5488/DALY averted and VL monitoring US$951-US$5813/DALY averted. We found no difference between POC- and laboratory-based VL monitoring, except for the highest measurement frequency (every 6 months), where laboratory-based testing was more effective. Targeted VL monitoring was on the cost-effectiveness frontier only if the difference between 1 st - and 2 nd -line costs remained large, and if we assumed that routine VL monitoring does not prevent failure. CONCLUSION: Compared with the less expensive strategies, the cost-effectiveness of routine VL monitoring essentially depends on the cost of 2 nd -line ART. Our Excel tool is useful for determining optimal monitoring strategies for specific settings, with specific sex-and age-distributions and unit costs. en_ZA
dc.language.iso eng en_ZA
dc.publisher Public Library of Science en_ZA
dc.rights This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/4.0 en_ZA
dc.source PLoS One en_ZA
dc.source.uri http://journals.plos.org/plosone en_ZA
dc.subject.other Antiretroviral therapy en_ZA
dc.subject.other Cost-effectiveness analysis en_ZA
dc.subject.other HIV clinical manifestations en_ZA
dc.subject.other HIV diagnosis and management en_ZA
dc.subject.other Global health en_ZA
dc.subject.other HIV en_ZA
dc.title The cost-effectiveness of monitoring strategies for antiretroviral therapy of HIV infected patients in resource-limited settings: software tool en_ZA
dc.type Journal Article en_ZA
dc.rights.holder © 2015 Estill et al en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Institute of Infectious Disease and Molecular Medicine en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Estill, J., Salazar-Vizcaya, L., Blaser, N., Egger, M., & Keiser, O. (2015). The cost-effectiveness of monitoring strategies for antiretroviral therapy of HIV infected patients in resource-limited settings: software tool. <i>PLoS One</i>, http://hdl.handle.net/11427/14993 en_ZA
dc.identifier.chicagocitation Estill, Janne, Luisa Salazar-Vizcaya, Nello Blaser, Matthias Egger, and Olivia Keiser "The cost-effectiveness of monitoring strategies for antiretroviral therapy of HIV infected patients in resource-limited settings: software tool." <i>PLoS One</i> (2015) http://hdl.handle.net/11427/14993 en_ZA
dc.identifier.vancouvercitation Estill J, Salazar-Vizcaya L, Blaser N, Egger M, Keiser O. The cost-effectiveness of monitoring strategies for antiretroviral therapy of HIV infected patients in resource-limited settings: software tool. PLoS One. 2015; http://hdl.handle.net/11427/14993. en_ZA
dc.identifier.ris TY - Journal Article AU - Estill, Janne AU - Salazar-Vizcaya, Luisa AU - Blaser, Nello AU - Egger, Matthias AU - Keiser, Olivia AB - BACKGROUND: The cost-effectiveness of routine viral load (VL) monitoring of HIV-infected patients on antiretroviral therapy (ART) depends on various factors that differ between settings and across time. Low-cost point-of-care (POC) tests for VL are in development and may make routine VL monitoring affordable in resource-limited settings. We developed a software tool to study the cost-effectiveness of switching to second-line ART with different monitoring strategies, and focused on POC-VL monitoring. METHODS: We used a mathematical model to simulate cohorts of patients from start of ART until death. We modeled 13 strategies (no 2 nd -line, clinical, CD4 (with or without targeted VL), POC-VL, and laboratory-based VL monitoring, with different frequencies). We included a scenario with identical failure rates across strategies, and one in which routine VL monitoring reduces the risk of failure. We compared lifetime costs and averted disability-adjusted life-years (DALYs). We calculated incremental cost-effectiveness ratios (ICER). We developed an Excel tool to update the results of the model for varying unit costs and cohort characteristics, and conducted several sensitivity analyses varying the input costs. RESULTS: Introducing 2 nd -line ART had an ICER of US$1651-1766/DALY averted. Compared with clinical monitoring, the ICER of CD4 monitoring was US$1896-US$5488/DALY averted and VL monitoring US$951-US$5813/DALY averted. We found no difference between POC- and laboratory-based VL monitoring, except for the highest measurement frequency (every 6 months), where laboratory-based testing was more effective. Targeted VL monitoring was on the cost-effectiveness frontier only if the difference between 1 st - and 2 nd -line costs remained large, and if we assumed that routine VL monitoring does not prevent failure. CONCLUSION: Compared with the less expensive strategies, the cost-effectiveness of routine VL monitoring essentially depends on the cost of 2 nd -line ART. Our Excel tool is useful for determining optimal monitoring strategies for specific settings, with specific sex-and age-distributions and unit costs. DA - 2015 DB - OpenUCT DO - 10.1371/journal.pone.0119299 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 T1 - The cost-effectiveness of monitoring strategies for antiretroviral therapy of HIV infected patients in resource-limited settings: software tool TI - The cost-effectiveness of monitoring strategies for antiretroviral therapy of HIV infected patients in resource-limited settings: software tool UR - http://hdl.handle.net/11427/14993 ER - en_ZA


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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Except where otherwise noted, this item's license is described as This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.