Clinical and economic outcomes of nonadherence to highly active antiretroviral therapy in patients with human immunodeficiency virus
Clinical and economic outcomes of nonadherence to highly active antiretroviral therapy in patients with human immunodeficiency virus
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DOI：
10.1097/01.mlr.0000233679.20898.e9
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发表时间：
2006-10-01
期刊：
影响因子：
3
通讯作者：
Tierce, Jonothan C.
中科院分区：
文献类型：
--
作者：
Munakata, Julie;Benner, Joshua S.;Tierce, Jonothan C.
背景资料：在典型的人类免疫缺陷病毒（HIV）患者护理环境中，不依从高效抗逆转录病毒治疗（HAART）很常见，但其后果尚未得到很好的描述。本研究的目的是量化的临床和经济的影响，不遵守和估计的成本效益，提高坚持治疗初治HIV patients.Methods：马尔可夫模型的开发项目的质量调整后的预期寿命和直接医疗费用的患者对初始每日一次的方案，依法韦仑，拉米夫定，司他夫定XR。该模型比较了2种依从性情景：“理想”（基于临床试验）和“典型”（基于实际实践中的观察性研究）。疾病进展是病毒载量、CD 4计数和依从性的函数。HIV的自然史，治疗的好处，成本和公用事业的数据来自于literature.Results：典型的坚持，患者失去1.2质量调整生命年（QHMS），可以获得理想的坚持。提高对理想水平的坚持是具有成本效益的，每增加一个质量调整生命年可获得29，400美元。每名患者可花费高达1600美元/年的干预费用，以提高对理想水平的依从性，增量成本效益仍低于50，000美元/QALY。一个成本效益比为50,000美元/QALY是一个普遍接受的最低标准，具有成本效益的医疗干预措施在美国，虽然许多专家认为，这个标准已经漂移向上随时间推移.Conclusions：典型的坚持与HAART降低质量调整后的预期寿命12%，理想的坚持。采取干预措施提高遵守率似乎是一种成本效益很高的资源利用方式。
Background: Nonadherence with highly active antiretroviral therapy (HAART) is common in typical human immunodeficiency virus (HIV) patient care settings, but the consequences have not been well described. This study aimed to quantify the clinical and economic effects of nonadherence and estimate the cost-effectiveness of improving adherence in treatment-naive HIV patients.Methods: A Markov model was developed to project quality-adjusted life expectancy and direct medical costs for patients on an initial once-daily regimen of efavirenz, lamivudine, and stavudine XR. The model compared 2 adherence scenarios: "ideal" (based on clinical trials) and "typical" (based on observational studies in actual practice). Disease progression was a function of viral load, CD4 count, and adherence. Data on HIV natural history, treatment benefits, costs, and utilities were derived from the literature.Results: With typical adherence, patients lose 1.2 quality-adjusted life years (QALYs) that could be gained with ideal adherence. Improving adherence to ideal levels is cost-effective at $29,400/ QALY gained. As much as $1600/y per patient could be spent on an intervention to improve adherence to ideal levels, and the incremental cost-effectiveness would remain less than $50,000/QALY gained. A cost-effectiveness ratio of $50,000/QALY is a commonly accepted minimum standard for cost-effective medical interventions in the United States, although many experts believe this standard has drifted upwards over time.Conclusions: Typical adherence with HAART reduces quality-adjusted life expectancy by 12% compared with ideal adherence. Interventions to improve adherence appear to be a highly cost-effective use of resources.