Cost effectiveness of a computer-delivered intervention to improve HIV medication adherence.
Cost effectiveness of a computer-delivered intervention to improve HIV medication adherence.
复制标题
计算机提供的干预措施以提高HIV药物依从性的成本效益。
DOI：
10.1186/1472-6947-13-29
复制
发表时间：
2013-02-28
影响因子：
3.5
通讯作者：
Caballero J
中科院分区：
文献类型：
--
作者：
Ownby RL;Waldrop-Valverde D;Jacobs RJ;Acevedo A;Caballero J
高度坚持治疗艾滋病毒感染的药物对于最佳临床结果和减少病毒传播至关重要，但许多患者没有达到所需的水平。临床医生提供的干预措施可以提高患者的依从性，但通常需要训练有素的个人付出大量努力，而且可能不会广泛使用。计算机提供的干预措施可以减少工作人员提供服务所需的时间，并通过互联网广泛提供干预措施，从而解决这一问题。我们之前开发了一种计算机提供的干预措施，旨在提高患者的健康素养水平，作为改善他们对艾滋病毒药物依从性的战略。该干预措施被证明提高了患者的依从性，但尚不清楚增加依从性所产生的好处是否能证明开发和部署干预措施的成本是合理的。这项研究的目的是评估开发和部署成本与干预效果的关系。干预发展的费用是从支持其发展的赠款的会计报告中提取的，并根据主要由项目研究目的产生的费用进行了调整。干预的有效性是从父母研究的结果中得出的。还评估了干预效果与健康状况变化的关系，以效用表示，以质量调整寿命年(QALY)来评估干预的净成本。敏感性分析评估了可能干预效果的范围及其效果的持续时间，并评估了几种部署方案的成本。干预措施的成本效益在很大程度上取决于使用它的人数及其有效性的持续时间。即使对少数患者有温和的影响，在某些情况下，干预与净成本节省相关，持续时间超过三个月或更长时间时，通常与每QALY的有利成本相关。对于中等和较大的假设效果和较长的干预效果持续时间，干预与净成本节省相关。计算机传递的依从性干预可能是一种成本效益高的策略，以提高接受艾滋病毒治疗的人的依从性。ClinicalTrials.gov标识符NCT01304186。
High levels of adherence to medications for HIV infection are essential for optimal clinical outcomes and to reduce viral transmission, but many patients do not achieve required levels. Clinician-delivered interventions can improve patients’ adherence, but usually require substantial effort by trained individuals and may not be widely available. Computer-delivered interventions can address this problem by reducing required staff time for delivery and by making the interventions widely available via the Internet. We previously developed a computer-delivered intervention designed to improve patients’ level of health literacy as a strategy to improve their HIV medication adherence. The intervention was shown to increase patients’ adherence, but it was not clear that the benefits resulting from the increase in adherence could justify the costs of developing and deploying the intervention. The purpose of this study was to evaluate the relation of development and deployment costs to the effectiveness of the intervention. Costs of intervention development were drawn from accounting reports for the grant under which its development was supported, adjusted for costs primarily resulting from the project’s research purpose. Effectiveness of the intervention was drawn from results of the parent study. The relation of the intervention’s effects to changes in health status, expressed as utilities, was also evaluated in order to assess the net cost of the intervention in terms of quality adjusted life years (QALYs). Sensitivity analyses evaluated ranges of possible intervention effectiveness and durations of its effects, and costs were evaluated over several deployment scenarios. The intervention’s cost effectiveness depends largely on the number of persons using it and the duration of its effectiveness. Even with modest effects for a small number of patients the intervention was associated with net cost savings in some scenarios and for durations greater than three months and longer it was usually associated with a favorable cost per QALY. For intermediate and larger assumed effects and longer durations of intervention effectiveness, the intervention was associated with net cost savings. Computer-delivered adherence interventions may be a cost-effective strategy to improve adherence in persons treated for HIV. Clinicaltrials.gov identifier NCT01304186.
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DOI：
10.1016/0749-5978(91)90020-t
发表时间：
1991-12-01
影响因子：
4.6
作者：
AJZEN, I
通讯作者：
AJZEN, I
影响因子：
4.4
作者：
Heckman, Timothy G.;Carlson, Bruce
通讯作者：
Carlson, Bruce
DOI：
10.1097/01.qai.0000248334.52072.25
发表时间：
2006-12-01
影响因子：
3.6
作者：
Freedberg, Kenneth A.;Hirschhorn, Lisa R.;Losina, Elena
通讯作者：
Losina, Elena
影响因子：
3
作者：
Braithwaite, R. Scott;Meltzer, David O.;Roberts, Mark S.
通讯作者：
Roberts, Mark S.
DOI：
10.1080/713612410
发表时间：
1998-06-01
影响因子：
1.7
作者：
Heckman, TG;Somlai, AM;Kelly, JA
通讯作者：
Kelly, JA