AEGiS-13IAC: Stategies for HIV care: clinical impact and cost-effectiveness.

13th International AIDS Conference


Durban, South Africa - July 9-July 14, 2000

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Stategies for HIV care: clinical impact and cost-effectiveness.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. ThPeB5228)

Freedberg K, Losina E, Weinstein MC, Paltiel AD, Cohen CJ, Seage GR, Craven D, Zhang H, Kimmel AD, Goldie SJ
K. Freedberg, Boston University School of Medicine, 91 E. Concord St, Suite 200, Boston 02118, United States, Tel.: +1 617 414 7399, Fax: +1 617 414 4676, E-mail: kfreedbe@bu.edu

BACKGROUND: It is difficult to prioritize among the proven therapies for HIV disease in situations with limited resources.

METHODS: We developed a state-transition model of HIV disease to project the clinical impact, cost, and cost-effectiveness (C-E) of different strategies for HIV care. Combinations of strategies included prophylaxis for PCP, MAC, and fungal infections, HAART with various regimens, and genotypic resistance testing (GART) at the time of HAART failure. CD4 count and HIV RNA were both used to determine clinical outcomes. Input data were from published trials, natural history and national cost datasets. Costs included monthly cost of AZT/3TC/indinavir ($967), azithromycin for MAC prophylaxis ($123), and GART ($400). The model was run for a hypothetical cohort of patients beginning with CD4 count 300/m l. Results indicate increasing quality-adjusted life expectancy in months (QALMs), lifetime per person cost, and incremental C-E in $/QALY as care is added.

RESULTS: Strategy/Medications QALMs Cost ($) C-E ($/QALY) No therapy 42.82 63,260 - PCP prophylaxis 46.65 64,670 4,400 PCP/HAART 71.80 92,460 13,300 PCP/HAART/GART 74.43 95,920 15,800 PCP/HAART/GART/MAC 75.11 96,990 18,900 Adding fluconazole for fungal prophylaxis had a C-E ratio above $60,000/QALY.

CONCLUSIONS: While HAART therapy has the greatest impact on survival, sequential addition of PCP prophylaxis, HAART, genotypic resistance testing and MAC prophylaxis are all cost-effective in the United States.

Keywords: AEGIS, Cost-Benefit Analysis, HIV Infections, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Quality-Adjusted Life Years, HIV Seropositivity, Azithromycin, Life Expectancy, United States, Human, economicsKWDaegis,cost-benefitanalysis,hivinfections,antiretroviraltherapy,highlyactive,cd4lymphocytecount,quality-adjustedlifeyears,hivseropositivity,azithromycin,lifeexpectancy,unitedstates,human,economics
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ThPeB5228

Copyright © 2000 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.