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

HIV Clin Trials. Sep-Oct 2010;11(5):248-59. doi: 10.1310/hct1105-248.

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.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS-Related Opportunistic Infections / drug therapy*
  • AIDS-Related Opportunistic Infections / economics*
  • AIDS-Related Opportunistic Infections / immunology
  • AIDS-Related Opportunistic Infections / microbiology
  • Adult
  • Anti-HIV Agents / administration & dosage*
  • Anti-HIV Agents / economics
  • CD4 Lymphocyte Count
  • Cohort Studies
  • Computer Simulation
  • Cost-Benefit Analysis
  • Disease Progression
  • Female
  • HIV / isolation & purification*
  • HIV Infections / drug therapy*
  • HIV Infections / economics*
  • HIV Infections / immunology
  • HIV Infections / microbiology
  • Humans
  • Life Expectancy
  • Male
  • Models, Economic
  • Models, Immunological
  • Quality-Adjusted Life Years

Substances

  • Anti-HIV Agents