Cost effectiveness analysis of clinically driven versus routine laboratory monitoring of antiretroviral therapy in Uganda and Zimbabwe
| Autor: | Medina Lara, Antonieta, Kigozi, Jesse, Amurwon, Jovita, Muchabaiwa, Lazarus, Nyanzi Wakaholi, Barbara, Mujica Mota, Ruben E, Walker, A Sarah, Kasirye, Ronnie, Ssali, Francis, Reid, Andrew, Grosskurth, Heiner, Babiker, Abdel G, Kityo, Cissy, Katabira, Elly, Munderi, Paula, Mugyenyi, Peter, Hakim, James, Darbyshire, Janet, Gibb, Diana M, Gilks, Charles F, DART Trial Team |
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| Jazyk: | angličtina |
| Rok vydání: | 2012 |
| Předmět: |
Male
Pediatrics Non-Clinical Medicine Total cost Cost-Benefit Analysis lcsh:Medicine HIV Infections Global Health Cost Effectiveness 0302 clinical medicine Science Policy and Economics Economic cost Health care Uganda 030212 general & internal medicine lcsh:Science health care economics and organizations Multidisciplinary Cost–benefit analysis HIV diagnosis and management Cost-effectiveness analysis 3. Good health Cohort Medicine Infectious diseases Female Quality-Adjusted Life Years Research Article Marginal cost Adult Zimbabwe medicine.medical_specialty Anti-HIV Agents Science Policy 030231 tropical medicine Retrovirology and HIV immunopathogenesis Viral diseases 03 medical and health sciences Health Economics Toxicity Tests medicine Humans Intensive care medicine business.industry lcsh:R HIV Quality-adjusted life year CD4 Lymphocyte Count lcsh:Q business Delivery of Health Care |
| Zdroj: | PLoS ONE PLoS ONE, Vol 7, Iss 4, p e33672 (2012) |
| ISSN: | 1932-6203 |
| Popis: | BACKGROUND: Despite funding constraints for treatment programmes in Africa, the costs and economic consequences of routine laboratory monitoring for efficacy and toxicity of antiretroviral therapy (ART) have rarely been evaluated. METHODS: Cost-effectiveness analysis was conducted in the DART trial (ISRCTN13968779). Adults in Uganda/Zimbabwe starting ART were randomised to clinically-driven monitoring (CDM) or laboratory and clinical monitoring (LCM); individual patient data on healthcare resource utilisation and outcomes were valued with primary economic costs and utilities. Total costs of first/second-line ART, routine 12-weekly CD4 and biochemistry/haematology tests, additional diagnostic investigations, clinic visits, concomitant medications and hospitalisations were considered from the public healthcare sector perspective. A Markov model was used to extrapolate costs and benefits 20 years beyond the trial. RESULTS: 3316 (1660LCM;1656CDM) symptomatic, immunosuppressed ART-naive adults (median (IQR) age 37 (32,42); CD4 86 (31,139) cells/mm(3)) were followed for median 4.9 years. LCM had a mean 0.112 year (41 days) survival benefit at an additional mean cost of $765 [95%CI:685,845], translating into an adjusted incremental cost of $7386 [3277,dominated] per life-year gained and $7793 [4442,39179] per quality-adjusted life year gained. Routine toxicity tests were prominent cost-drivers and had no benefit. With 12-weekly CD4 monitoring from year 2 on ART, low-cost second-line ART, but without toxicity monitoring, CD4 test costs need to fall below $3.78 to become cost-effective ( |
| Databáze: | OpenAIRE |
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