Evaluating interventions to improve antiretroviral adherence: how much of an effect is required for favorable value?
Evaluating interventions to improve antiretroviral adherence: how much of an effect is required for favorable value?
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DOI：
10.1111/j.1524-4733.2010.00714.x
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发表时间：
2010-08
期刊：
影响因子：
--
通讯作者：
Justice AC
中科院分区：
文献类型：
--
作者：
Braithwaite RS;Fiellin DA;Nucifora K;Bryant K;Roberts M;Kim N;Justice AC
对抗逆转录病毒治疗(ARV)依从性干预措施价值的不确定性可能是实施和评估的障碍。我们的目标是评估抗逆转录病毒药物依从性干预提供可接受价值所需的最低有效性。我们使用经过验证的HIV计算机模拟来评估抗逆转录病毒药物依从性干预措施对增量成本和预期寿命的影响。在广泛的干预成本范围(1,000-10,000美元，一次或每年)中，我们估计了与可接受值(增量成本-效果比≤为每生命年100,000美元)相容的最小效果大小，使用相对风险(RR)和绝对风险降低(ARR)来衡量效果大小，并将这些指标应用于不遵守和不坚持的风险因素。从社会角度估计的费用(2003年美元)折现3%。为了给出可接受的值，一次性1,000美元的干预必须减少RR≤0.82(ARR≥0.04)对于中度未依从性患者(错过20%的抗逆转录病毒剂量)和RR≤0.90(ARR≥0.05)对于严重不依从性患者(50%的抗逆转录病毒疫苗未达标)。对于中度不依从性的患者，一次性5,000美元的干预具有不可接受的价值，无论效果大小如何，并且对于严重不依从性的患者，必须将抗逆转录病毒不依从性减少RR≤0.31(ARR≥0.69)。针对行为危险因素的干预措施(例如不健康的酒精使用)可提供可接受的值(例如，If≤$2000和Effect RR≤0.71[ARR≥0.29])。效果看似合理的抗逆转录病毒药物依从性干预措施可能会提供有利的价值，因为它们一次或每年花费5000美元。具有有利价值的抗逆转录病毒药物依从性干预措施应该成为艾滋病毒护理的更不可或缺的组成部分。
Uncertainty about the value of antiretroviral therapy (ARV) adherence interventions may be a barrier to implementation and evaluation. Our objective is to estimate the minimum effectiveness required for ARV adherence interventions to deliver acceptable value. We used a validated HIV computer simulation to estimate the impact of ARV adherence interventions on incremental costs and life expectancy. Across a wide range of intervention costs ($1000–10,000, one time or per year), we estimated the smallest effect size compatible with acceptable value (incremental cost-effective ratio ≤$100,000 per life-year), Effect sizes were measured using relative risk (RR) and absolute risk reduction (ARR), and these metrics were applied to nonadherence and nonadherence risk factors. Costs were estimated from a societal perspective ($2003) discounted at 3%. To give acceptable value, a one-time $1000 intervention must reduce ARV nonadherence by RR ≤ 0.82 (ARR ≥ 0.04) for moderately nonadherent patients (20% of ARV doses missed) and RR ≤ 0.90 (ARR ≥ 0.05) for severely nonadherent patients (50% of ARV doses missed). A one-time $5000 intervention has an unacceptable value regardless of effect size for moderately nonadherent patients, and must reduce ARV nonadherence by RR ≤ 0.31 (ARR ≥ 0.69) for severely nonadherent patients. Interventions aimed at behavioral risk factors (e.g.. unhealthy alcohol use) may confer acceptable value (e.g., if ≤$2000 and effect RR ≤ 0.71 [ARR ≥ 0.29]). ARV adherence interventions with plausible effect sizes may offer favorable value it they cost <$5000 one time or per year. ARV adherence interventions with a favorable value should become more integral components of HIV care.
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