Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
Preventing Mycobacterium avium complex in patients who are using protease inhibitors: a cost-effectiveness analysis.
AIDS. 1998 Aug 20;12(12):1503-12. Unique Identifier : AIDSLINE MED/98394555 Bayoumi AM; Redelmeier DA; Department of Medicine, University of Toronto, Canada.
Abstract:
BACKGROUND: Practice guidelines recommending Mycobacterium avium complex (MAC) prophylaxis for patients with HIV disease were based on clinical trials in which individuals did not receive protease inhibitors. OBJECTIVE: To estimate the cost-effectiveness of strategies for MAC prophylaxis in patients whose treatment regimen includes protease inhibitors. DESIGN: Decision analysis with Markov modelling of the natural history of advanced HIV disease. Five strategies were evaluated: no prophylaxis, azithromycin, rifabutin, clarithromycin and a combination of azithromycin plus rifabutin. MAIN OUTCOME MEASURES: Survival, quality of life, quality-adjusted survival, health care costs and marginal cost-effectiveness ratios. RESULTS: Compared with no prophylaxis, rifabutin increased life expectancy from 78 to 80 months, increased quality-adjusted life expectancy from 50 to 52 quality-adjusted months and increased health care costs from $233000 to $239800. Ignoring time discounting and quality of life, the cost-effectiveness of rifabutin relative to no prophylaxis was $44300 per life year. Adjusting for time discounting and quality of life, the cost-effectiveness of rifabutin relative to no prophylaxis was $41500 per quality-adjusted life year (QALY). In comparison with rifabutin, azithromycin was associated with increased survival, increased costs and an incremental cost-effectiveness ratio of $54300 per QALY. In sensitivity analyses, prophylaxis remained economically attractive unless the lifetime chance of being diagnosed with MAC was less than 20%, the rate of CD4 count decline was less than 10 x 10(6) cells/l per year, or the CD4 count was greater than 50 x 10(6) cells/l. CONCLUSION: MAC prophylaxis increases quality-adjusted survival at a reasonable cost, even in patients using protease inhibitors. When not contraindicated, starting azithromycin or rifabutin when the patient's CD4 count is between 50 and 75 x 10(6) cells/l is the most cost-effective strategy. The main determinants of cost-effectiveness are CD4 count, viral load, place of residence and patient preference.
Keywords: JOURNAL ARTICLE Adult Antibiotic Prophylaxis/*ECONOMICS Antibiotics, Antitubercular Antibiotics, Macrolide Azithromycin AIDS-Related Opportunistic Infections/ECONOMICS/MORTALITY/ *PREVENTION & CONTROL Clarithromycin Cost-Benefit Analysis Drug Therapy, Combination Health Care Costs Human HIV Infections/*DRUG THERAPY/MORTALITY HIV Protease Inhibitors/*THERAPEUTIC USE Male Markov Chains *Mycobacterium avium Complex Mycobacterium avium-intracellulare Infection/ECONOMICS/MORTALITY/ *PREVENTION & CONTROL Quality of Life Rifabutin Support, Non-U.S. Gov't United States 990130
A9911030
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Important note: Information in this article was accurate in 1999. The state of the art may have changed since the publication date.
