Should Resistance Testing Be Performed for Treatment-Naive HIV-Infected Patients? A Cost-Effectiveness Analysis

Sax, Paul E.; Islam, Runa; Walensky, Rochelle P.; Losina, Elena; Weinstein, Milton C.; Goldie, Sue J.; Sadownik, Sara N.; Freedberg, Kenneth A.

doi:10.1086/496984

Cited by 176 publications

(102 citation statements)

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“…Nevertheless, while the absolute PPPM costs may vary between centres, the relative differences in costs between CD4 categories and temporal trends are widely recognized. While our monthly costs are somewhat lower than reported elsewhere under different healthcare systems, our cost differences and disease stages as well as in-patient care trends are highly consistent with others [6,20,[25][26][27][28]32]. Our study describes costs over the past 9 years.…”

Section: Discussionsupporting

confidence: 89%

Cost of medical care for HIV‐infected patients within a regional population from 1997 to 2006

Krentz

Gill

2008

HIV Medicine

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ObjectivesTo report on the cost of medical care for HIV-infected patients stratified by CD4 cell count for a regional population over a 9-year period, and to examine the effect of reporting costs of HIV care only or only in antiretroviral therapy (ART)-experienced patients. MethodsRetrospective costing analysis on all HIV-infected patients within the Southern Alberta Cohort from April 1997 to April 2006. Costs for all drugs (ART/non-ART), in-patient (HIV/non-HIV) and outpatient care were obtained from primary sources. Costs were aggregated by patient's CD4 cell count and ART exposure and presented as mean cost per patient per month (PPPM) in 2006 Canadian dollars. ResultsThe number of patients and annual costs increased by 74% and 69%, respectively. Overall mean PPPM costs increased slightly from $1082 in 1997/1998 to $1159 in 2005/2006. PPPM costs for patients with CD4 counts 75 cells/mL increased from $1595 to $2687 while costs for CD4 counts 4500, 201-500 and 76-200 cells/mL remained relatively stable at $979, $1057 and $1294, respectively. In-patient hospitalization costs account for most of the cost increases. Reporting costs using only ART-experienced patients would overestimate total costs by 2-9%. Costs for only HIV care were 10-24% lower than total care costs. ConclusionsCare costs have remained relatively stable for most HIV patients except those with CD4 counts 75 cells/mL. Expensive new antiretroviral drugs have had, at present, a minimal cost impact. Enhanced testing to achieve earlier diagnosis and initiation of highly active antiretroviral therapy could potentially reduce costs of late presentation and in-patient care.Keywords: AIDS, cost of care, healthcare costs, health economics, HIV Received: 10 January 2008, accepted 24 April 2008 Introduction Guidelines issued by the British HIV Association, the European AIDS Clinical Society, the Centers for Disease Control and Prevention (CDC), the Department of Health and Social Services and other agencies recommending who should get tested for HIV infection and who should initiate highly active antiretroviral therapy (HAART) evolve continually and may swiftly and dramatically impact healthcare costs for an HIV-infected population. Healthcare planners, policy makers and practitioners need to have current data on costs and costing trends for the entire HIVinfected population in order to project trends and to allocate funds effectively. However, reporting on the cost of medical care from a payee's perspective for an entire HIVinfected population remains problematic. Most direct costing studies [1] obtain their cost measurements from a variety of sources including hospital costing surveys, administrative databases from one or several clinics, and national-level surveys. Although the cost estimates are comprehensive for the patients being surveyed, many individuals diagnosed with HIV infection may not be included if they are 'healthy' (i.e. high CD4 cell counts), not accessing specialized HIV care on a regular basis, not Because it is increasingly difficult a...

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Section: Discussionsupporting

confidence: 89%

Cost of medical care for HIV‐infected patients within a regional population from 1997 to 2006

Krentz

Gill

2008

HIV Medicine

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“…Approximately 7% of our study population had interpreted baseline resistance to NNRTIs, an ARV class included as components of preferred and alternative regimens for patients naïve to ARVs by the DHHS guidelines (DHHS, 2913). Resistance testing has been shown to be costeffective in the United States unless the local resistance is ≤1% (Sax et al, 2005). Due to the relatively low levels of Pr mutations, our findings also support the use of a boosted PI regimen when empiric ARV therapy must be initiated before GART results are available.…”

Section: Discussionsupporting

confidence: 62%

Human immunodeficiency virus (HIV) in Washington, D.C.: Prevalence of antiretroviral resistance in treatment nave patients from 2007 to 2010

Swierzbinski¹,

Kan²,

Parenti³

2015

J. AIDS HIV Res.

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“…In a population, genotypic antiretroviral resistance testing is considered cost-effective for acute and chronic HIV-1 infection when drug resistant transmitted levels are À5z (19). Several studies have shown that at least 10z of new primary HIV-1-infected individuals are resistant to at least one antiretroviral drug (20)(21)(22).…”

Section: Discussionmentioning

confidence: 99%

HIV-1 Subtypes and Primary Antiretroviral Resistance Mutations in Antiretroviral Therapy Naive HIV-1 Infected Individuals in Turkey

et al. 2013

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Should Resistance Testing Be Performed for Treatment-Naive HIV-Infected Patients? A Cost-Effectiveness Analysis

Abstract: Genotype-resistance testing of chronically HIV-infected, antiretroviral-naive patients is likely to improve clinical outcomes and is cost-effective, compared with other HIV care in the United States. Resistance testing at the time of diagnosis should be the standard of care.

Cited by 176 publications

References 40 publications

Cost of medical care for HIV‐infected patients within a regional population from 1997 to 2006

Cost of medical care for HIV‐infected patients within a regional population from 1997 to 2006

Human immunodeficiency virus (HIV) in Washington, D.C.: Prevalence of antiretroviral resistance in treatment nave patients from 2007 to 2010

HIV-1 Subtypes and Primary Antiretroviral Resistance Mutations in Antiretroviral Therapy Naive HIV-1 Infected Individuals in Turkey

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