Modeling Adherence Interventions Among Youth with HIV in the United States: Clinical and Economic Projections
| Autor: | Milton C. Weinstein, Kimberly A. Powers, Caitlin M Dugdale, Anne M. Neilan, Allison L. Agwu, Kenneth A. Freedberg, Kunjal Patel, H. Jonathon Rendina, Audrey C. Bangs, Emily P. Hyle, Catherine M. Crespi, Aditya H. Gaur, Ingrid V. Bassett, Rochelle P. Walensky, Andrea L. Ciaranello, Michael G. Hudgens, Keith J. Horvath |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Adolescent Social Psychology Cost effectiveness Cost-Benefit Analysis Psychological intervention Intervention HIV Infections 030312 virology Adolescents 03 medical and health sciences Adolescent medicine 0302 clinical medicine Acquired immunodeficiency syndrome (AIDS) medicine Humans 030212 general & internal medicine Young adult health care economics and organizations Original Paper 0303 health sciences business.industry Public health Modeling Public Health Environmental and Occupational Health HIV medicine.disease United States Health psychology Infectious Diseases Adherence Life expectancy Cost-effectiveness Quality-Adjusted Life Years business Young adults Demography |
| Zdroj: | AIDS and Behavior |
| ISSN: | 1573-3254 1090-7165 |
| DOI: | 10.1007/s10461-021-03169-0 |
| Popis: | The Adolescent Medicine Trials Network for HIV/AIDS Interventions is evaluating treatment adherence interventions (AI) to improve virologic suppression (VS) among youth with HIV (YWH). Using a microsimulation model, we compared two strategies: standard-of-care (SOC) and a hypothetical 12-month AI that increased cohort-level VS in YWH in care by an absolute ten percentage points and cost $100/month/person. Projected outcomes included primary HIV transmissions, deaths and life-expectancy, lifetime HIV-related costs, and incremental cost-effectiveness ratios (ICERs, $/quality-adjusted life-year [QALY]). Compared to SOC, AI would reduce HIV transmissions by 15% and deaths by 12% at 12 months. AI would improve discounted life expectancy/person by 8 months at an added lifetime cost/person of $5,300, resulting in an ICER of $7,900/QALY. AI would be cost-effective at $2,000/month/person or with efficacies as low as a 1 percentage point increase in VS. YWH-targeted adherence interventions with even modest efficacy could improve life expectancy, prevent onward HIV transmissions, and be cost-effective.La Red de Ensayos Médicos sobre Adolescentes para Realizar Intervenciones sobre el VIH/SIDA está evaluando intervenciones de adherencia (IAs) al tratamiento para mejorar la supresión virológica (SV) entre los jóvenes con VIH (JCV). Usando un modelo de microsimulación, comparamos dos estrategias: cuidado convencional (CC) y una intervención de adherencia hipotética durando 12 meses que aumentaría la SV a nivel de cohorte entre JCV en tratamiento por 10 puntos de porcentuales y que costaría US$ 100/mes/persona. Resultados proyectados incluyeron transmisiones de VIH primarias, muertes y esperanza de vida, costos de por vida asociados con el VIH, y razones incrementales de costo-efectividad (RICEs, $/año de vida ajustado por la calidad [AVAC]). Comparado al CC, la IA reduciría transmisiones de VIH por 15% y muertes por 12% a los 12 meses. La IA mejoraría esperanza de vida descontada/persona por 8 meses a un costo de por vida adicional/persona de US$ 5.300, resultando en una RICE de US$ 7.900/AVAC. La IA sería costo-efectiva a un costo de US$ 2.000/mes/persona o si mejorara SV por al menos un punto porcentual. Intervenciones de adherencia dirigidas a jóvenes con una eficacia incluso modesta podrían mejorar esperanza de vida, prevenir transmisiones de VIH, y ser costo-efectivas. |
| Databáze: | OpenAIRE |
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