Pin40: The Cost Effectiveness of Improved Adherence to Antiretroviral Treatment

Zaric, Gregory S.; Am, Bayoumi; Brandeau, ML; Owens, D. K.

doi:10.1016/s1098-3015(10)64017-x

Cited by 3 publications

(2 citation statements)

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“…The model results were consistent for clinical trial cohorts with early or late disease and for an urban observational cohort with intermediate disease (Goldie et al, 2003). Another modelling study found that counselling patients at the initiation of antiretroviral therapy and after virologic failure at a cost of $50/counseling session would meet the same cost-effectiveness threshold even with modest gains in adherence (Goldie et al, 2003;Zaric et al, 2003). A third modelling study found that interventions costing up to $138/month could meet the threshold if they improved adherence from a level reported in observational studies (76% of prescribed doses consumed on average) to a level observed in some HIV clinical trials (98% of prescribed doses consumed) (Munakata et al, 2004).…”

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confidence: 54%

The cost of HIV medication adherence support interventions: Results of a cross-site evaluation

et al. 2005

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The objective of this study was to determine the direct cost of HIV adherence support programmes participating in a cross-site evaluation in the US. Data on the frequency, type, and setting of adherence encounters; providers' professions; and adherence tools provided were collected for 1,122 patients enrolled in 13 interventions at 9 sites. The site staff estimated the average duration of each type of encounter and national wage rates were used for labour costs. The median (range) adherence encounters/year among interventions was 16.5 (4.3-104.6) per patient; encounters lasted 24.6 (8.9-40.9) minutes. Intervention direct cost was correlated with the average frequency of encounters (r = 0.57), but not with encounter duration or providers' professions. The median direct cost/month was 35 dollars(5 dollars-58 dollars) per patient, and included direct provider costs (66%); incentives (17%); reminders and other tools (8%); and direct administrative time, provider transportation, training, and home delivery (9%). The median direct cost/month from a societal perspective, which includes patient time and travel costs, was 47 dollars(24 dollars-114 dollars) per patient. Adherence interventions with moderate efficacy costing < or =100 dollars/month have been estimated to meet a cost-effectiveness threshold that is generally accepted in the US. Payers should consider enhanced reimbursement for adherence support services.

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confidence: 54%

The cost of HIV medication adherence support interventions: Results of a cross-site evaluation

et al. 2005

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“…Marseille et grams was a crucial determinant in these studies. Zaric et al [165] al. [155] compared a range of long-and short-course ART combina-studied the impact of enhanced voluntary maternal testing and tions and found that the most efficient approach was targeted routine newborn testing and found that implementing the practices single-dose nevirapine for mother and child, with a cost-effective-jointly would have an additional cost of less than $US11 000 per ness ratio of $US5.25 per DALY before infant treatment costs LYG.…”

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confidence: 99%

Efficiency of Interventions in HIV Infection, 1994???2004

Harling

Wood

Beck

2005

Disease Management & Health Outcomes

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Economic implications of nonadherence to highly active antiretroviral treatment in HIV patients

Lamiraud¹,

Moatti²

2006

Expert Opinion on Pharmacotherapy

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Until now, the economic implications of nonadherence to drug therapies have been mostly assessed in a cost perspective and understood as the impact of nonadherence behaviours on the cost-effectiveness ratios of particular therapies. In HIV disease, some modelling approaches have suggested that high adherence levels might improve the cost-effectiveness of highly active antiretroviral treatment regimens. However, there is an urgent need for research directly observing and measuring the costs of nonadherence behaviours. In addition to this cost perspective, the authors argue that the economic impact of nonadherence should also be studied in a microeconomic--patient-oriented--perspective. Major implications of this microeconomic perspective are drawn. First, the microeconomic approach highlights that nonadherence may often be a rational choice of the patient, thus suggesting new ways for improving adherence. Second, it implies that the adherence behaviour can be interpreted as an indicator of patients' subjective valuation of highly active antiretroviral treatment therapies; in particular, higher levels of adherence are associated with higher patient well-being. Third, it shows that the adherence behaviour cannot be regarded as an exogenous variable when the impact of adherence on health outcome or on cost-effectiveness ratios is studied, thus requiring the use of specific statistical or econometric methods.

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Pin40: The Cost Effectiveness of Improved Adherence to Antiretroviral Treatment

Cited by 3 publications

References 0 publications

The cost of HIV medication adherence support interventions: Results of a cross-site evaluation

The cost of HIV medication adherence support interventions: Results of a cross-site evaluation

Efficiency of Interventions in HIV Infection, 1994???2004

Economic implications of nonadherence to highly active antiretroviral treatment in HIV patients

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