IDEAS home Printed from https://ideas.repec.org/a/sae/medema/v18y1998i2_supplps93-s105.html
   My bibliography  Save this article

A Monte Carlo Simulation of Advanced HIV Disease

Author

Listed:
  • A. David Paltiel
  • Julie A. Scharfstein
  • George R. Seage
  • Elena Losina
  • Sue J. Goldie
  • Milton C. Weinstein
  • Donald E. Craven
  • Kenneth A. Freedberg

Abstract

Background. Disagreement exists among decision makers regarding the allocation of limited HIV patient care resources and, specifically, the comparative value of prevent ing opportunistic infections in late-stage disease. Methods. A Monte Carlo simulation framework was used to evaluate a state-transition model of the natural history of HIV illness in patients with CD4 counts below 300/mm 3 and to project the costs and con sequences of alternative strategies for preventing AIDS-related complications. The au thors describe the model and demonstrate how it may be employed to assess the cost-effectiveness of oral ganciclovir for prevention of cytomegalovirus (CMV) infec tion. Results. Ganciclovir prophylaxis confers an estimated additional 0.7 quality-ad justed month of life at a net cost of $10,700, implying an incremental cost-effective ness ratio of roughly $173,000 per quality-adjusted life year gained. Sensitivity analysis reveals that this baseline result is stable over a wide range of input data estimates, including quality of life and drug efficacy, but it is sensitive to CMV incidence and drug price assumptions. Conclusions. The Monte Carlo simulation framework offers decision makers a powerful and flexible tool for evaluating choices in the realm of chronic disease patient care. The authors have used it to assess HIV-related treatment options and continue to refine it to reflect advances in defining the pathogenesis and treatment of AIDS. Compared with alternative interventions, CMV prophylaxis does not appear to be a cost-effective use of scarce HIV clinical care funds. However, targeted pre vention in patients identified to be at higher risk for CMV-related disease may warrant consideration. Key words: Monte Carlo simulation; AIDS; HIV infection; cytomegalo virus infection; cost-effectiveness analysis. (Med Decis Making 1998;18suppl:S93- S105)

Suggested Citation

  • A. David Paltiel & Julie A. Scharfstein & George R. Seage & Elena Losina & Sue J. Goldie & Milton C. Weinstein & Donald E. Craven & Kenneth A. Freedberg, 1998. "A Monte Carlo Simulation of Advanced HIV Disease," Medical Decision Making, , vol. 18(2_suppl), pages 93-105, April.
    • Handle: RePEc:sae:medema:v:18:y:1998:i:2_suppl:p:s93-s105
    DOI: 10.1177/0272989X98018002S11
    as

    Download full text from publisher

    File URL: https://journals.sagepub.com/doi/10.1177/0272989X98018002S11
    Download Restriction: no
    File URL: https://libkey.io/10.1177/0272989X98018002S11?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Seage III, G.R. & Oddleifson, S. & Carr, E. & Shea, B. & Makarewicz-Robert, L. & Van Beuzekom, M. & De Maria, A., 1993. "Survival with AIDS in Massachusetts, 1979 to 1989," American Journal of Public Health, American Public Health Association, vol. 83(1), pages 72-78.
    2. Torrance, George W., 1976. "Social preferences for health states: An empirical evaluation of three measurement techniques," Socio-Economic Planning Sciences, Elsevier, vol. 10(3), pages 129-136.
    3. Drummond, Michael & Torrance, George & Mason, James, 1993. "Cost-effectiveness league tables: More harm than good?," Social Science & Medicine, Elsevier, vol. 37(1), pages 33-40, July.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Gilles Pialoux & Anne-Geneviève Marcelin & Nicolas Despiégel & Caroline Espinas & Hélène Cawston & Laurent Finkielsztejn & Audrey Laurisse & Céline Aubin, 2015. "Cost-Effectiveness of Dolutegravir in HIV-1 Treatment-Experienced (TE) Patients in France," PLOS ONE, Public Library of Science, vol. 10(12), pages 1-14, December.
    2. Yazdan Yazdanpanah & Caroline E Sloan & Cécile Charlois-Ou & Stéphane Le Vu & Caroline Semaille & Dominique Costagliola & Josiane Pillonel & Anne-Isabelle Poullié & Olivier Scemama & Sylvie Deuffic-Bu, 2010. "Routine HIV Screening in France: Clinical Impact and Cost-Effectiveness," PLOS ONE, Public Library of Science, vol. 5(10), pages 1-9, October.
    3. Anthony O'Hagan & Matt Stevenson & Jason Madan, 2007. "Monte Carlo probabilistic sensitivity analysis for patient level simulation models: efficient estimation of mean and variance using ANOVA," Health Economics, John Wiley & Sons, Ltd., vol. 16(10), pages 1009-1023, October.
    4. Yazdan Yazdanpanah & Julian Perelman & Madeline A DiLorenzo & Joana Alves & Henrique Barros & Céu Mateus & João Pereira & Kamal Mansinho & Marion Robine & Ji-Eun Park & Eric L Ross & Elena Losina & Ro, 2013. "Routine HIV Screening in Portugal: Clinical Impact and Cost-Effectiveness," PLOS ONE, Public Library of Science, vol. 8(12), pages 1-1, December.
    5. Anthony O'Hagan & Matt Stevenson & Jason Madan, 2007. "Monte Carlo probabilistic sensitivity analysis for patient level simulation models: efficient estimation of mean and variance using ANOVA," Health Economics, John Wiley & Sons, Ltd., vol. 16(10), pages 1009-1023.
    6. Thomas Hoffmann & Helmut Brunner, 2004. "Model for simulation of HIV/AIDS and cost-effectiveness of preventing non-tuberculous mycobacterial (MAC)-disease," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 5(2), pages 129-135, May.
    7. Steven M. Shechter & Matthew D. Bailey & Andrew J. Schaefer & Mark S. Roberts, 2008. "The Optimal Time to Initiate HIV Therapy Under Ordered Health States," Operations Research, INFORMS, vol. 56(1), pages 20-33, February.
    8. Marta O. Soares & Luísa Canto e Castro, 2012. "Continuous Time Simulation and Discretized Models for Cost-Effectiveness Analysis," PharmacoEconomics, Springer, vol. 30(12), pages 1101-1117, December.
    9. Marta Soares & Luísa Canto e Castro, 2012. "Continuous Time Simulation and Discretized Models for Cost-Effectiveness Analysis," PharmacoEconomics, Springer, vol. 30(12), pages 1101-1117, December.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Ann E. Clarke, 1997. "Arthritis Patient Education: How Economic Evaluations Can Inform Health Policy," Canadian Public Policy, University of Toronto Press, vol. 23(s1), pages 162-176, Spring.
    2. John Vernon & Robert Goldberg & Joseph Golec, 2009. "Economic Evaluation and Cost-Effectiveness Thresholds," PharmacoEconomics, Springer, vol. 27(10), pages 797-806, October.
    3. Hilary A. Llewellyn-Thomas & J. Ivan Williams & Linda Levy & C.D. Naylor, 1996. "Using a Trade-off Technique to Assess Patients' Treatment Preferences for Benign Prostatic Hyperplasia," Medical Decision Making, , vol. 16(3), pages 262-272, August.
    4. Tappenden, P & Brazier, J & Ratcliffe, J, 2006. "Does the National Institute for Health and Clinical Excellence take account of factors such as uncertainty and equity as well as incremental cost-effectiveness in commissioning health care services? A," MPRA Paper 29772, University Library of Munich, Germany.
    5. Rutten, Frans, 1996. "Economic evaluation and health care decision-making," Health Policy, Elsevier, vol. 36(3), pages 215-229, June.
    6. Robert J. Brent, 2012. "The Effects Of Hiv Medications On The Quality Of Life Of Older Adults In New York City," Health Economics, John Wiley & Sons, Ltd., vol. 21(8), pages 967-976, August.
    7. Coast, Joanna, 2018. "A history that goes hand in hand: Reflections on the development of health economics and the role played by Social Science & Medicine, 1967–2017," Social Science & Medicine, Elsevier, vol. 196(C), pages 227-232.
    8. Heather J. Sutherland & Hilary Llewellyn-Thomas & Norman F. Boyd & James E. Till, 1982. "Attitudes Toward Quality of Survival," Medical Decision Making, , vol. 2(3), pages 299-309, August.
    9. Milton C. Weinstein, 1981. "Economic Assessments of Medical Practices and Technologies," Medical Decision Making, , vol. 1(4), pages 309-330, December.
    10. Benjamin Matthew Craig & Kim Rand & John D. Hartman, 2022. "Preference Paths and Their Kaizen Tasks for Small Samples," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 15(2), pages 187-196, March.
    11. Wolfgang C. Winkelmayer & Milton C. Weinstein & Murray A. Mittleman & Robert J. Glynn & Joseph S. Pliskin, 2002. "Health Economic Evaluations: The Special Case of End-Stage Renal Disease Treatment," Medical Decision Making, , vol. 22(5), pages 417-430, October.
    12. Peter A. Ubel & George Loewenstein, 2008. "Pain and Suffering Awards: They Shouldn't Be (Just) about Pain and Suffering," The Journal of Legal Studies, University of Chicago Press, vol. 37(S2), pages 195-216, June.
    13. Cookson, Richard & Hutton, John, 2003. "Regulating the economic evaluation of pharmaceuticals and medical devices: a European perspective," Health Policy, Elsevier, vol. 63(2), pages 167-178, February.
    14. Paul Dolan & Claire Gudex, 1995. "Time preference, duration and health state valuations," Health Economics, John Wiley & Sons, Ltd., vol. 4(4), pages 289-299, July.
    15. George W. Torrance & David Feeny & William Furlong, 2001. "Visual Analog Scales," Medical Decision Making, , vol. 21(4), pages 329-334, August.
    16. Tom Jefferson & Miranda Mugford & Alastair Gray & Vittorio Demicheli, 1996. "An exercise on the feasibility of carrying out secondary economic analyses," Health Economics, John Wiley & Sons, Ltd., vol. 5(2), pages 155-165, March.
    17. Peter A. Ubel & George Loewenstein & Dennis Scanlon & Mark Kamlet, 1996. "Individual Utilities Are Inconsistent with Rationing Choices," Medical Decision Making, , vol. 16(2), pages 108-116, June.
    18. Marisa Santos & Monica A. C. T. Cintra & Andrea L. Monteiro & Braulio Santos & Fernando Gusmão-filho & Mônica Viegas Andrade & Kenya Noronha & Luciane N. Cruz & Suzi Camey & Bernardo Tura & Paul Kin, 2016. "Brazilian Valuation of EQ-5D-3L Health States," Medical Decision Making, , vol. 36(2), pages 253-263, February.
    19. Peter Hertzman, 2005. "The cost effectiveness of orlistat in a 1-year weight-management programme for treating overweight and obese patients in Sweden," PharmacoEconomics, Springer, vol. 23(10), pages 1007-1020, October.
    20. Paul F M Krabbe, 2013. "A Generalized Measurement Model to Quantify Health: The Multi-Attribute Preference Response Model," PLOS ONE, Public Library of Science, vol. 8(11), pages 1-12, November.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:sae:medema:v:18:y:1998:i:2_suppl:p:s93-s105. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: SAGE Publications (email available below). General contact details of provider: .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.