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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Cost-effectiveness of point-of-care viral load monitoring of antiretroviral therapy in resource-limited settings: Mathematical modelling study
AIDS, Volume 27, No. 9, Year 2013
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Description
Background: Monitoring of HIV viral load in patients on combination antiretroviral therapy (ART) is not generally available in resource-limited settings. We examined the cost-effectiveness of qualitative point-of-care viral load tests (POC-VL) in sub-Saharan Africa. Design: Mathematical model based on longitudinal data from the Gugulethu and Khayelitsha township ART programmes in Cape Town, South Africa. Methods: Cohorts of patients on ART monitored by POC-VL, CD4 cell count or clinically were simulated. Scenario A considered the more accurate detection of treatment failure with POC-VL only, and scenario B also considered the effect on HIV transmission. Scenario C further assumed that the risk of virologic failure is halved with POC-VL due to improved adherence. We estimated the change in costs per quality-adjusted life-year gained (incremental cost-effectiveness ratios, ICERs) of POC-VL compared with CD4 and clinical monitoring. Results: POC-VL tests with detection limits less than 1000 copies/ml increased costs due to unnecessary switches to second-line ART, without improving survival. Assuming POC-VL unit costs between US$5 and US$20 and detection limits between 1000 and 10 000 copies/ml, the ICER of POC-VL was US$4010-US$9230 compared with clinical and US$5960-US$25540 compared with CD4 cell count monitoring. In Scenario B, the corresponding ICERs were US$2450-US$5830 and US$2230-US$10380. In Scenario C, the ICER ranged between US$960 and US$2500 compared with clinical monitoring and between cost-saving and US$2460 compared with CD4 monitoring. Conclusion: The cost-effectiveness of POC-VL for monitoring ART is improved by a higher detection limit, by taking the reduction in new HIV infections into account and assuming that failure of first-line ART is reduced due to targeted adherence counselling. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Estill, Janne Anton Markus
Switzerland, Bern
University of Bern
Egger, Matthias
Switzerland, Bern
University of Bern
Blaser, Nello
Switzerland, Bern
University of Bern
Salazar-Vizcaya, Luisa
Switzerland, Bern
University of Bern
Garone, Daniela Belen
Switzerland, Geneva
Medecins Sans Frontieres
Wood, Robin Y.
South Africa, Cape Town
University of Cape Town
Campbell, Jennifer R.
United States, Boston
Clinton Health Access Initiative, Inc.
Hallett, Timothy B.
United Kingdom, London
Imperial College London
Keiser, Olivia
Switzerland, Bern
University of Bern
Statistics
Citations: 48
Authors: 9
Affiliations: 5
Identifiers
Doi:
10.1097/QAD.0b013e328360a4e5
e-ISSN:
14735571
Research Areas
Infectious Diseases
Study Design
Cohort Study
Study Approach
Qualitative
Study Locations
South Africa