Analysis of the costs and cost-effectiveness of the guidelines recommended by the 2018 GESIDA/Spanish National AIDS Plan for initial antiretroviral therapy in HIV-infected adults

Pérez‐Molina, José A.; Martínez, Estebán; Blasco, Antonio Javier; Arribas, José Ramón; Domingo, Peré; Iribarren, José Antonio; Knobel, Hernando; Lázaro, Pablo; López‐Aldeguer, José; Lozano, Fernando; Mariño, Ana; Miró, José M.; Moreno, Santiago; Negredo, Eugènia; Pulido, Federico; Rubio, Rafael; Santos, Jesús; Torre, Javier de la; Tuset, Montserrat; Wichmann, Miguel Ángel von; Gatell, Josep M.

doi:10.1016/j.eimc.2018.04.010

Cited by 6 publications

(3 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results are similar to those of other studies on DT with DTG plus 3TC in pretreated HIV infected patients. [20,30] Although the results do not rule out DTG/ABC/3TC or EVG/cobi/FTC/TAF as cost-effective options, [31] especially in patients who are not good candidates for DT, the combination of DTG and 3TC proved to be a more cost-effective approach, reducing the costs by patient/yrs.…”

Section: Discussionmentioning

confidence: 99%

DOLAMA study

et al. 2019

Self Cite

View full text Add to dashboard Cite

Dolutegravir (DTG) has shown effectiveness in combination with rilpivirine in with experience of antiretroviral therapy (ART) and with 3TC in naïve patients (GEMINI trial). The main objectives of this real-life study were to analyze the effectiveness and safety of 3TC plus DTG in virologically suppressed HIV-1 patients and to conduct a pharmacoeconomic analysis. We conducted an observational, retrospective and multicenter study of HIV+ patients pretreated for at least 6 months with ART that was then simplified to 3TC + DTG for any reason. We gathered data on viral loads (VLs) during exposure to the DT, calculating the rate with VL < 50 copies/mL at week 48, and on associated adverse effects. The 177 HIV+ patients were collected, 77.4% male, with average age of 48.5 years and mean count of 252.2cell/μL CD4+ nadir lymphocytes; 96.6% had VL < 50 copies/mL and 674 cells/μL CD4+ lymphocytes. Median time since HIV diagnosis was 15 years, and median ART duration was 13 years, and 34.5% of patients were on mono- or dual-therapy before the switch. At week 48, 82.4% of patients had VL < 50 cop/μL using an intention-to-treat (ITT) analysis, 89.6% according to mITT, and 96.7% according to Per-Protocol analysis. 3.3% patients had virological failure (VF). These effectiveness data and costs were compared with those for 2 reference triple therapies (DTG/ABC/3TC and EVG/cobi/FTC/TAF) in a cost minimization analysis, showing cost savings with administration of DTG+3TC (2741 €/year vs DTG/ABC/3TC and 4164 €/year vs EVG/cobi/FTC/TAF) and in a cost-effectiveness analysis, finding the DT to be the most cost-effective approach (ICER = −548 vs DTG/ABC/3TC and ICER = −4,627€ vs EVG/cobi/FTC/TAF) The combination of 3TC with DTG appears to be a safe and effective option for the simplification of ART in pretreated and virologically stable HIV-positive patients, being cost-effective and offering the same effectiveness as the triple therapy it replaces.

show abstract

Section: Discussionmentioning

confidence: 99%

DOLAMA study

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…Previous studies have investigated different influencing factors on the medical burden of ART, including the drug combination or dose,[ 2 , 7 , 9 , 10 ] treatment scheme,[ 2 , 5 , 11 ] and others. [ 3 , 4 , 12 13 14 15 16 ] The factors of drug and testing fees were found to dominate the medical costs of ART.…”

Section: Introductionmentioning

confidence: 99%

Subdividing ART patients and analyzing the medical burden by modeling of CD4 cell count

Wang

2023

Journal of Family Medicine and Primary Care

View full text Add to dashboard Cite

A BSTRACT Objective: To subdivide the antiretroviral therapy (ART) human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) patients by modeling the CD4 cell count variable, with an aim to reduce the medical burden from lifelong ART. Materials and Methods: The data of outpatients at the research unit between August 2009 and December 2020 were exported and mined. A recency-frequency (RF) model was established for data subdivision, and data of non-churn ART patients were preserved. Common factor analysis (CFA) was conducted on the three indicators of the baseline/mean/last CD4 cell counts to obtain critical variables; then, k-means modeling was used to subdivide ART patients and their medical burden was analyzed. Results: A total of 12,106 samples of non-churn ART patients were preserved by RF modeling. The baseline/mean/last CD4 cell counts served as important variables employed for modeling. The patients were divided into 15 types, including two types with poor compliance and poor immune reconstitution, two types with good compliance but poor immune reconstitution, four types with poor compliance but good immune reconstitution, and seven types with good compliance and good immune reconstitution. The frequency of visits was 5.25–9.95 visits/person/year, and the percentage of examination fees was 44.24%–59.05%, with a medical burden of 4114.24–12,676.66 yuan/person/year, of which 42.62%–70.09% was reduced. Conclusion: The CD4 cell count is not only an important indicator for judging post-ART immune recovery, but also a major modeling variable in subdividing ART patients with varying medical burdens. Poor compliance and poor immune reconstitution lead to excessive visits and frequent examinations, which were the leading causes of the heavy medical burden of ART.

show abstract

“…In recent years, some systematic reviews have shown that interventions based on medical consultations, nursing consultations, telephone calls, text messaging, financial incentives and behavioral therapy have improved adherence to ART, but none has carried out an assessment from an economic and epidemiological perspective, aiming to demonstrate how these interventions interfere in the long term in the incidence of new cases ( 3 - 4 , 9 , 12 - 14 ) . In this sense, non-medication and cost-effective interventions, from an economic point of view, such as sending text messages, can help maintain adherence throughout ART without dispensing high costs to the health system and with easy applicability for large populations regardless of their location and facility to the health system ( 7 , 14 - 15 ) . In addition, few studies estimate the impact of these interventions on the population scenario, considering their costs and the possibility of reducing new infections.…”

Section: Introductionmentioning

confidence: 99%

Economic and epidemiological evaluation of text message-based interventions in patients with the Human Immunodeficiency Virus

Santos

Primeira

Paiva

et al. 2020

Rev. Latino-Am. Enfermagem

View full text Add to dashboard Cite

Objective: to evaluate the cost-effectiveness ratio and the budget impact of sending text messages associated with medical consultations in order to reduce the viral load of patients infected with the Human Immunodeficiency Virus. Method: a randomized clinical trial, basis for the development of a dynamic cohort model with Markov states in order to compare medical appointments for adults infected with the Human Immunodeficiency Virus versus the alternative strategy that associated medical consultations to sending text messages through telephone. Results: 156 adults participated in the study. As for the viral load, it was verified that in the control group there was an increase, in the intervention group A (weekly messages) there was a reduction (p = 0.002) and in group B (biweekly messages) there was no statistically significant difference. Sending text messages would prevent 286,538 new infections by the Human Immunodeficiency Virus and 282 deaths in the 20-year period, compared to the standard treatment. The alternative strategy would result in saving R$ 14 billion in treatment costs. Conclusion: weekly sending messages in association with the standard treatment can reduce the circulating viral load due to its effect in decreasing new infections, in addition to reducing health costs.

show abstract

Analysis of the costs and cost-effectiveness of the guidelines recommended by the 2018 GESIDA/Spanish National AIDS Plan for initial antiretroviral therapy in HIV-infected adults

Cited by 6 publications

References 23 publications

DOLAMA study

DOLAMA study

Subdividing ART patients and analyzing the medical burden by modeling of CD4 cell count

Economic and epidemiological evaluation of text message-based interventions in patients with the Human Immunodeficiency Virus

Contact Info

Product

Resources

About