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Cost-effectiveness of genotypic antiretroviral resistance testing in HIV-infected patients with treatment failure.
PLoS One. 2007 Jan 24; 2(1):e173.Plos

Abstract

BACKGROUND

Genotypic antiretroviral resistance testing (GRT) in HIV infection with drug resistant virus is recommended to optimize antiretroviral therapy, in particular in patients with virological failure. We estimated the clinical effect, cost and cost-effectiveness of using GRT as compared to expert opinion in patients with antiretroviral treatment failure.

METHODS

We developed a mathematical model of HIV disease to describe disease progression in HIV-infected patients with treatment failure and compared the incremental impact of GRT versus expert opinion to guide antiretroviral therapy. The analysis was conducted from the health care (discount rate 4%) and societal (discount rate 2%) perspective. Outcome measures included life-expectancy, quality-adjusted life-expectancy, health care costs, productivity costs and cost-effectiveness in US Dollars per quality-adjusted life-year (QALY) gained. Clinical and economic data were extracted from the large Swiss HIV Cohort Study and clinical trials.

RESULTS

Patients whose treatment was optimized with GRT versus expert opinion had an increase in discounted life-expectancy and quality-adjusted life-expectancy of three and two weeks, respectively. Health care costs with and without GRT were $US 421,000 and $US 419,000, leading to an incremental cost-effectiveness ratio of $US 35,000 per QALY gained. In the analysis from the societal perspective, GRT versus expert opinion led to an increase in discounted life-expectancy and quality-adjusted life-expectancy of three and four weeks, respectively. Health care costs with and without GRT were $US 551,000 and $US 549,000, respectively. When productivity changes were included in the analysis, GRT was cost-saving.

CONCLUSIONS

GRT for treatment optimization in HIV-infected patients with treatment failure is a cost-effective use of scarce health care resources and beneficial to the society at large.

Authors+Show Affiliations

Division of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Basel, Switzerland. pedram.sendi@unibas.chNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17245449

Citation

Sendi, Pedram, et al. "Cost-effectiveness of Genotypic Antiretroviral Resistance Testing in HIV-infected Patients With Treatment Failure." PloS One, vol. 2, no. 1, 2007, pp. e173.
Sendi P, Günthard HF, Simcock M, et al. Cost-effectiveness of genotypic antiretroviral resistance testing in HIV-infected patients with treatment failure. PLoS One. 2007;2(1):e173.
Sendi, P., Günthard, H. F., Simcock, M., Ledergerber, B., Schüpbach, J., & Battegay, M. (2007). Cost-effectiveness of genotypic antiretroviral resistance testing in HIV-infected patients with treatment failure. PloS One, 2(1), e173.
Sendi P, et al. Cost-effectiveness of Genotypic Antiretroviral Resistance Testing in HIV-infected Patients With Treatment Failure. PLoS One. 2007 Jan 24;2(1):e173. PubMed PMID: 17245449.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness of genotypic antiretroviral resistance testing in HIV-infected patients with treatment failure. AU - Sendi,Pedram, AU - Günthard,Huldrych F, AU - Simcock,Mathew, AU - Ledergerber,Bruno, AU - Schüpbach,Jörg, AU - Battegay,Manuel, AU - ,, Y1 - 2007/01/24/ PY - 2006/11/29/received PY - 2006/12/22/accepted PY - 2007/1/25/pubmed PY - 2007/1/25/medline PY - 2007/1/25/entrez SP - e173 EP - e173 JF - PloS one JO - PLoS One VL - 2 IS - 1 N2 - BACKGROUND: Genotypic antiretroviral resistance testing (GRT) in HIV infection with drug resistant virus is recommended to optimize antiretroviral therapy, in particular in patients with virological failure. We estimated the clinical effect, cost and cost-effectiveness of using GRT as compared to expert opinion in patients with antiretroviral treatment failure. METHODS: We developed a mathematical model of HIV disease to describe disease progression in HIV-infected patients with treatment failure and compared the incremental impact of GRT versus expert opinion to guide antiretroviral therapy. The analysis was conducted from the health care (discount rate 4%) and societal (discount rate 2%) perspective. Outcome measures included life-expectancy, quality-adjusted life-expectancy, health care costs, productivity costs and cost-effectiveness in US Dollars per quality-adjusted life-year (QALY) gained. Clinical and economic data were extracted from the large Swiss HIV Cohort Study and clinical trials. RESULTS: Patients whose treatment was optimized with GRT versus expert opinion had an increase in discounted life-expectancy and quality-adjusted life-expectancy of three and two weeks, respectively. Health care costs with and without GRT were $US 421,000 and $US 419,000, leading to an incremental cost-effectiveness ratio of $US 35,000 per QALY gained. In the analysis from the societal perspective, GRT versus expert opinion led to an increase in discounted life-expectancy and quality-adjusted life-expectancy of three and four weeks, respectively. Health care costs with and without GRT were $US 551,000 and $US 549,000, respectively. When productivity changes were included in the analysis, GRT was cost-saving. CONCLUSIONS: GRT for treatment optimization in HIV-infected patients with treatment failure is a cost-effective use of scarce health care resources and beneficial to the society at large. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/17245449/Cost_effectiveness_of_genotypic_antiretroviral_resistance_testing_in_HIV_infected_patients_with_treatment_failure_ L2 - https://dx.plos.org/10.1371/journal.pone.0000173 DB - PRIME DP - Unbound Medicine ER -