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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
The clinical and economic impact of genotype testing at first-line antiretroviral therapy failure for HIV-infected patients in South Africa
Clinical Infectious Diseases, Volume 56, No. 4, Year 2013
Notification
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Description
Background. In resource-limited settings, genotype testing at virologic failure on first-line antiretroviral therapy (ART) may identify patients with wild-type (WT) virus. After adherence counseling, these patients may safely and effectively continue first-line ART, thereby delaying more expensive second-line ART.Methods. We used the Cost-Effectiveness of Preventing AIDS Complications International model of human immunodeficiency virus (HIV) disease to simulate a South African cohort of HIV-infected adults at first-line ART failure. Two strategies were examined: no genotype vs genotype, assuming availability of protease inhibitor-based second-line ART. Model inputs at first-line ART failure were mean age 38 years, mean CD4 173/μL, and WT virus prevalence 20%; genotype cost was $300 per test and delay to results, 3 months. Outcomes included life expectancy, per-person costs (2010 US dollars), and incremental cost-effectiveness ratios (dollars per years of life saved [YLS]).Results. No genotype had a projected life expectancy of 106.1 months, which with genotype increased to 108.3 months. Per-person discounted lifetime costs were $16 360 and $16 540, respectively. Compared to no genotype, genotype was very cost-effective, by international guidance, at $900/YLS. The cost-effectiveness of genotype was sensitive to prevalence of WT virus (very cost-effective when prevalence ≥12%), CD4 at first-line ART failure, and ART efficacy. Genotype-associated delays in care ≥5 months decreased survival and made no genotype the preferred strategy. When the test cost was <$100, genotype became cost-saving. Conclusions. Genotype resistance testing at first-line ART failure is very cost-effective in South Africa. The cost-effectiveness of this strategy will depend on prevalence of WT virus and timely response to genotype results. © 2012 The Author 2012. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup. com.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3552524/bin/supp_56_4_587__index.html
https://efashare.b-cdn.net/share/pmc/articles/PMC3552524/bin/supp_cis887_cis887supp.doc
Authors & Co-Authors
Levison, Julie H.
United States, Boston
Massachusetts General Hospital
United States, Akron
Division of Infectious Diseases
United States, Boston
Harvard Medical School
Wood, Robin Y.
South Africa, Cape Town
University of Cape Town
Scott, Callie A.
United States, Boston
Massachusetts General Hospital
Ciaranello, Andrea L.
United States, Boston
Massachusetts General Hospital
United States, Boston
Harvard Medical School
Martinson, Neil Alexander
South Africa, Johannesburg
University of the Witwatersrand
United States, Baltimore
Johns Hopkins School of Medicine
Rusu, Corina
United States, Boston
Massachusetts General Hospital
Losina, Elena
United States, Boston
Massachusetts General Hospital
United States, Buffalo
Departments of Biostatistics
United States, Boston
Brigham and Women's Hospital
United States, Cambridge
Harvard University
United States, Boston
Harvard Medical School
Freedberg, Kenneth A.
United States, Boston
Massachusetts General Hospital
United States, Boston
Boston University
United States, Cambridge
Harvard University
United States, Boston
Harvard Medical School
Walensky, Rochelle P.
United States, Boston
Massachusetts General Hospital
United States, Akron
Division of Infectious Diseases
United States, Cambridge
Harvard University
United States, Boston
Harvard Medical School
Statistics
Citations: 38
Authors: 9
Affiliations: 10
Identifiers
Doi:
10.1093/cid/cis887
ISSN:
10584838
e-ISSN:
15376591
Research Areas
Genetics And Genomics
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
South Africa