Cost Effectiveness Analysis of Clinically Driven versus Routine Laboratory Monitoring of Antiretroviral Therapy in Uganda and Zimbabwe

摘要: BACKGROUND: Despite funding constraints for treatment programmes in Africa, the costs and economic consequences of routine laboratory monitoring efficacy toxicity antiretroviral therapy (ART) have rarely been evaluated. METHODS: Cost-effectiveness analysis was conducted DART trial (ISRCTN13968779). Adults Uganda/Zimbabwe starting ART were randomised to clinically-driven (CDM) or clinical (LCM); individual patient data on healthcare resource utilisation outcomes valued with primary utilities. Total first/second-line ART, 12-weekly CD4 biochemistry/haematology tests, additional diagnostic investigations, clinic visits, concomitant medications hospitalisations considered from public sector perspective. A Markov model used extrapolate benefits 20 years beyond trial. RESULTS: 3316 (1660LCM;1656CDM) symptomatic, immunosuppressed ART-naive adults (median (IQR) age 37 (32,42); 86 (31,139) cells/mm(3)) followed median 4.9 years. LCM had a mean 0.112 year (41 days) survival benefit at an cost $765 [95%CI:685,845], translating into adjusted incremental $7386 [3277,dominated] per life-year gained $7793 [4442,39179] quality-adjusted life gained. Routine tests prominent cost-drivers no benefit. With 2 low-cost second-line but without monitoring, test need fall below $3.78 become cost-effective (<3xper-capita GDP, following WHO benchmarks). current as undertaken not long-term. CONCLUSIONS: There is rationale which did affect costly. Even though beneficial, there little justification low-income African countries. restricted second onwards, could be lower development cheaper, ideally point-of-care, test.