Important note: Information in this article was accurate in June 2002. The state of the art may have changed since the publication date.AIDSWEEKLY Plus; June 10, 2002
Michael Greer, Senior Medical Writer
"Human immunodeficiency virus (HIV)-infected patients receiving highly active antiretroviral therapy (HAART) have experienced a dramatic decrease in Pneumocystis carinii pneumonia (PCP), necessitating reassessment of clinical guidelines for prophylaxis," explained Dr. Sue J. Goldie and colleagues at Harvard University, Boston University, and Massachusetts General Hospital in Boston, the U.S. Centers for Disease Control and Prevention in Atlanta, Yale University in New Haven, Connecticut, and the Community Research Initiative New England in Brookline, Massachusetts.
Goldie and coauthors were able to determine the most cost-effective points to halt PCP prophylaxis, as well as the most cost-effective prophylactic agents, according to their report.
The researchers used a simulation model to find the quality-adjusted life expectancy (QALE) and cost per quality-adjusted life year (QALY) for a number of prophylaxis end points in patients whose CD4 cell counts rose during highly active antiretroviral therapy (HAART). The cost-effectiveness of alternative agents for patients unable to tolerate standard trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis were also examined, they said.
Delaying the end of prophylaxis until CD4 cell counts rose to at least 300 cells/µL saved US$9400/QALY compared with prophylactic regimens ending at a CD4 cell count of only 200 cells/µL, study data showed. Moreover, the decision to wait until CD4 cell counts hit at least 300 cells/µL prevented 9 PCP infections per 1000 patients treated.
Dapsone provided efficacy similar to that of atovaquone in TMP/SMX-intolerant patients and cost only US$4500/QALY, in contrast to atovaquone's price tag of more than US$1.5 million/QALY (Prophylaxis for human immunodeficiency virus-related Pneumocystis carinii pneumonia - Using simulation modeling to inform clinical guidelines, Arch Intern Med 2002 Apr 22;162(8):921-8.
"Delaying discontinuation of PCP prophylaxis until the first observed CD4 cell count greater than 300/µL is cost-effective and provides an explicit 'PCP prophylaxis stopping criterion,'" Goldie and colleagues concluded. "In TMP/SMX-intolerant patients, dapsone is more cost effective than atovaquone."
The corresponding author for this report is Sue J. Goldie, MD, MPH, Center for Risk Analysis, Department of Health Policy and Management, Harvard School of Public Health, 718 Huntington Ave, Second Floor, Boston, MA 02115, USA.
A search at www.NewsRx.net using the search term "AIDS and HIV therapy" yielded 1101 articles in 27 specialized reports.
Key points reported in this study include:
This article was prepared by AIDS Weekly editors from staff and other reports.
020610
AW020604
Copyright © 2002 - Charles Henderson, Publisher. All rights Reserved. Permission to reproduce granted to AEGIS by Charles W. Henderson. Authorization to reproduce for personal use granted granted by C. W. Henderson, Publisher, provided that the fee of US$4.50 per copy, per page is paid directly to the Copyright Clearance Center, 27 Congress Street, Salem, Massachusetts 01970, USA. Published by Charles Henderson, Publisher. Editorial & Publishing Office: P.O. Box 5528, Atlanta, GA 30307-0528 / Telephone: (800) 633-4931; Subscription Office: P.O. Box 830409, Birmingham, AL 35283-0409 / FAX: (205) 995-1588 http://www.newsrx.net
AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, iMetrikus, Inc., the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 2002. This material is designed to support, not replace, the relationship that exists between you and your doctor.
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.
Copyright © 1980,2002. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content.