Laboratory Monitoring of Antiretroviral Therapy for HIV Infection: Cost-Effectiveness and Budget Impact of Current and Novel Strategies

摘要: BACKGROUND Optimal laboratory monitoring of antiretroviral therapy (ART) for human immunodeficiency virus (HIV) remains controversial. We evaluated current and novel strategies in Cote d'Ivoire, West Africa. METHODS used the Cost-Effectiveness Preventing AIDS Complications -International model to compare clinical outcomes, cost-effectiveness, budget impact 11 ART varying by type (CD4 and/or viral load [VL]) frequency. included "adaptive" (biannual then annual patients on ART/suppressed). Mean CD4 count at initiation was 154/μL. Laboratory test costs were CD4=$11 VL=$33. The standard care (SOC; biannual CD4) comparator. assessed cost-effectiveness relative d'Ivoire's 2013 per capita GDP ($1500). RESULTS Discounted life expectancy 16.69 years SOC, 16.97 with VL confirmation immunologic failure, 17.25 adaptive VL. time failed first-line 3.7 SOC <0.9 all routine/adaptive strategies. failure cost-saving compared SOC. Adaptive had an incremental ratio (ICER) $4100/year saved increased 5-year $310/patient achieved ICER <1× if second-line simultaneously decreased $156 $13, respectively. CONCLUSIONS is more effective less costly than d'Ivoire. reduces failing ART, cost-effective, should become d'Ivoire similar settings.