Early antiretroviral therapy for patients with acute aids-related opportunistic infections: a cost-effectiveness analysis of ACTG A5164.

TitleEarly antiretroviral therapy for patients with acute aids-related opportunistic infections: a cost-effectiveness analysis of ACTG A5164.
Publication TypeJournal Article
Year of Publication2010
AuthorsSax PE, Sloan CE, Schackman BR, Grant PM, Rong J, Zolopa AR, Powderly W, Losina E, Freedberg KA
Corporate AuthorsCepac US And Actg A5164 Investigators
JournalHIV Clin Trials
Volume11
Issue5
Pagination248-59
Date Published2010 Sep-Oct
ISSN1528-4336
KeywordsAdult, AIDS-Related Opportunistic Infections, Anti-HIV Agents, CD4 Lymphocyte Count, Cohort Studies, Computer Simulation, Cost-Benefit Analysis, Disease Progression, Female, HIV, HIV Infections, Humans, Life Expectancy, Male, Models, Economic, Models, Immunological, Quality-Adjusted Life Years
Abstract

PURPOSE: ACTG A5164 demonstrated that early antiretroviral therapy (ART) in HIV-infected patients with acute opportunistic infections (OIs) reduced death and AIDS progression compared to ART initiation 1 month later. We project the life expectancies, costs, and incremental cost-effectiveness ratios (ICERs) of these strategies.

METHOD: using an HIV simulation model, we compared 2 strategies for patients with acute OIs: (1) an intervention to deliver early ART, and (2) deferred ART. Parameters from ACTG A5164 included initial mean CD4 count (47/microL), linkage to outpatient care (87%), and immune reconstitution inflammatory syndrome 1 month after ART initiation (7%). The estimated intervention cost was $1,650/patient.

RESULTS: early ART lowered projected 1-year mortality from 10.4% to 8.2% and increased life expectancy from 10.07 to 10.39 quality-adjusted life-years (QALYs). Lifetime costs increased from $385,220 with deferred ART to $397,500 with early ART, primarily because life expectancy increased, producing an ICER of $38,600/QALY. Results were most sensitive to increased intervention cost and decreased virologic efficacy in the early ART strategy.

CONCLUSIONS: an intervention to initiate ART early in patients with acute OIs improves survival and meets US cost-effectiveness thresholds. Programs should be developed to implement this strategy at sites where HIV-infected patients present with OIs.

DOI10.1310/hct1105-248
Alternate JournalHIV Clin Trials
PubMed ID21126955
PubMed Central IDPMC3183461
Grant ListAI027666 / AI / NIAID NIH HHS / United States
AI069556 / AI / NIAID NIH HHS / United States
K24 AI062476 / AI / NIAID NIH HHS / United States
K24 AI062476 / AI / NIAID NIH HHS / United States
R01 AI042006 / AI / NIAID NIH HHS / United States
R37 AI042006 / AI / NIAID NIH HHS / United States
R37 AI042006 / AI / NIAID NIH HHS / United States
U01 AI027666 / AI / NIAID NIH HHS / United States
U01 AI068636 / AI / NIAID NIH HHS / United States
U01 AI068636 / AI / NIAID NIH HHS / United States
U01 AI069419 / AI / NIAID NIH HHS / United States
U01 AI069419 / AI / NIAID NIH HHS / United States
U01 AI069556 / AI / NIAID NIH HHS / United States