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Cost-Effectiveness of Genotypic Antiretroviral Resistance Testing in HIV-Infected Patients with Treatment Failure

Author

Listed:
  • Pedram Sendi
  • Huldrych F Günthard
  • Mathew Simcock
  • Bruno Ledergerber
  • Jörg Schüpbach
  • Manuel Battegay
  • for the Swiss HIV Cohort Study

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.

Suggested Citation

  • Pedram Sendi & Huldrych F Günthard & Mathew Simcock & Bruno Ledergerber & Jörg Schüpbach & Manuel Battegay & for the Swiss HIV Cohort Study, 2007. "Cost-Effectiveness of Genotypic Antiretroviral Resistance Testing in HIV-Infected Patients with Treatment Failure," PLOS ONE, Public Library of Science, vol. 2(1), pages 1-8, January.
    • Handle: RePEc:plo:pone00:0000173
    DOI: 10.1371/journal.pone.0000173
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    References listed on IDEAS

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    1. Pedram Sendi & Werner B. F. Brouwer, 2005. "Is silence golden? A test of the incorporation of the effects of ill‐health on income and leisure in health state valuations," Health Economics, John Wiley & Sons, Ltd., vol. 14(6), pages 643-647, June.
    2. Andrew H. Briggs & Ron Goeree & Gord Blackhouse & Bernie J. O’Brien, 2002. "Probabilistic Analysis of Cost-Effectiveness Models: Choosing between Treatment Strategies for Gastroesophageal Reflux Disease," Medical Decision Making, , vol. 22(4), pages 290-308, August.
    3. Andrew H. Briggs & A. E. Ades & Martin J. Price, 2003. "Probabilistic Sensitivity Analysis for Decision Trees with Multiple Branches: Use of the Dirichlet Distribution in a Bayesian Framework," Medical Decision Making, , vol. 23(4), pages 341-350, July.
    4. Frank A. Sonnenberg & J. Robert Beck, 1993. "Markov Models in Medical Decision Making," Medical Decision Making, , vol. 13(4), pages 322-338, December.
    5. David Meltzer & Magnus Johannesson, 1999. "Inconsistencies in the "Societal Perspective" on Costs of the Panel on Cost-Effectiveness in Health and Medicine," Medical Decision Making, , vol. 19(4), pages 371-377, October.
    6. Magnus Johannesson & David Meltzer, 1998. "Editorial: Some reflections on cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 7(1), pages 1-7, February.
    7. Peter Doubilet & Colin B. Begg & Milton C. Weinstein & Peter Braun & Barbara J. McNeil, 1985. "Probabilistic Sensitivity Analysis Using Monte Carlo Simulation," Medical Decision Making, , vol. 5(2), pages 157-177, June.
    8. Maria G.M. Hunink & Jan Roelf Bult & Jelle De Vries & Milton C. Weinstein, 1998. "Uncertainty in Decision Models Analyzing Cost-Effectiveness," Medical Decision Making, , vol. 18(3), pages 337-346, August.
    9. Magnus Johannesson & David Meltzer & Richard M. O'Conor, 1997. "Incorporating Future Costs in Medical Cost-Effectiveness Analysis," Medical Decision Making, , vol. 17(4), pages 382-389, October.
    10. Ben A. Van Hout & Maiwenn J. Al & Gilad S. Gordon & Frans F. H. Rutten, 1994. "Costs, effects and C/E‐ratios alongside a clinical trial," Health Economics, John Wiley & Sons, Ltd., vol. 3(5), pages 309-319, September.
    11. Andrew H. Briggs, 1999. "A Bayesian approach to stochastic cost‐effectiveness analysis," Health Economics, John Wiley & Sons, Ltd., vol. 8(3), pages 257-261, May.
    12. Karl Claxton & Mark Sculpher & Chris McCabe & Andrew Briggs & Ron Akehurst & Martin Buxton & John Brazier & Tony O'Hagan, 2005. "Probabilistic sensitivity analysis for NICE technology assessment: not an optional extra," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 339-347, April.
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