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.authorEstill, Janneen_ZA
dc.contributor.authorSalazar-Vizcaya, Luisaen_ZA
dc.contributor.authorBlaser, Nelloen_ZA
dc.contributor.authorEgger, Matthiasen_ZA
dc.contributor.authorKeiser, Oliviaen_ZA
dc.date.accessioned2015-11-16T04:09:33Z
dc.date.available2015-11-16T04:09:33Z
dc.date.issued2015en_ZA
dc.description.abstractBACKGROUND: 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.identifier.apacitationEstill, 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/11427/14993en_ZA
dc.identifier.chicagocitationEstill, 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/11427/14993en_ZA
dc.identifier.citationEstill, 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.0119299en_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
dc.identifier.urihttp://hdl.handle.net/11427/14993
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0119299
dc.identifier.vancouvercitationEstill 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.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis 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.holder© 2015 Estill et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherAntiretroviral therapyen_ZA
dc.subject.otherCost-effectiveness analysisen_ZA
dc.subject.otherHIV clinical manifestationsen_ZA
dc.subject.otherHIV diagnosis and managementen_ZA
dc.subject.otherGlobal healthen_ZA
dc.subject.otherHIVen_ZA
dc.titleThe cost-effectiveness of monitoring strategies for antiretroviral therapy of HIV infected patients in resource-limited settings: software toolen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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