Cost-effectiveness of an intervention to improve adherence to antiretroviral therapy in HIV-infected patients

J Acquir Immune Defic Syndr. 2006 Dec 1;43 Suppl 1:S113-8. doi: 10.1097/01.qai.0000248334.52072.25.

Abstract

Adherence to antiretroviral medications has been shown to be an important factor in predicting viral suppression and clinical outcomes. The objective of this analysis was to assess the cost-effectiveness of a nursing intervention on antiretroviral adherence using data from a randomized controlled clinical trial as input to a computer-based simulation model of HIV disease. For a cohort of HIV-infected patients similar to those in the clinical trial (mean initial CD4 count of 319 cells/mm), implementing the nursing intervention in addition to standard care yielded a 63% increase in virologic suppression at 48 weeks. This produced increases in expected survival (from 94.5 to 100.9 quality-adjusted life months) and estimated discounted direct lifetime medical costs ($253,800 to $261,300). The incremental cost-effectiveness ratio for the intervention was $14,100 per quality-adjusted life year gained compared with standard care. Adherence interventions with modest effectiveness are likely to provide long-term survival benefit to patients and to be cost-effective compared with other uses of HIV care funds.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Anti-HIV Agents / administration & dosage*
  • Anti-HIV Agents / therapeutic use
  • Computer Simulation
  • Cost-Benefit Analysis
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / nursing*
  • Health Care Costs / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Models, Statistical
  • Patient Compliance*
  • Sensitivity and Specificity

Substances

  • Anti-HIV Agents