HIV cure strategies: how good must they be to improve on current antiretroviral therapy?
HIV cure strategies: how good must they be to improve on current antiretroviral therapy?
复制标题
DOI：
10.1371/journal.pone.0113031
复制
发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Freedberg KA
中科院分区：
文献类型：
--
作者：
Sax PE;Sypek A;Berkowitz BK;Morris BL;Losina E;Paltiel AD;Kelly KA;Seage GR 3rd;Walensky RP;Weinstein MC;Eron J;Freedberg KA
我们检查了假设的HIV治愈干预措施的疗效、毒性、复发、成本和生活质量阈值，这些干预措施与终身抗逆转录病毒治疗（ART）相比具有成本效益。我们使用计算机模拟模型来评估三种HIV治愈策略：基因治疗，化疗和干细胞移植（SCT），每种都与ART进行比较。结果包括质量调整的预期寿命，终身成本，和成本效益的美元/质量调整的生命年（$/QALY）获得。战略被认为具有成本效益，增量成本效益比<100，000美元/QALY。对于接受抗逆转录病毒治疗的患者，折扣后的质量调整预期寿命为16.4年，终身成本为591，400美元。基因治疗具有成本效益，疗效为10%，复发率为0.5%/月，费用为54，000美元。化疗是成本效益的，有效率为88%，复发率为0.5%/月，24个月的费用为12，400美元/月。在150，000美元/程序，SCT具有成本效益，有效率为79%，复发率为0.5%/月。适度的疗效增加和成本降低使基因治疗节省成本，但需要实质性的疗效/成本变化来使化疗或SCT节省成本。根据疗效、复发率和成本，与目前的ART相比，治愈策略可能具有成本效益，并可能节省成本。这些结果可能有助于为开发艾滋病毒治疗策略提供性能目标。
We examined efficacy, toxicity, relapse, cost, and quality-of-life thresholds of hypothetical HIV cure interventions that would make them cost-effective compared to life-long antiretroviral therapy (ART). We used a computer simulation model to assess three HIV cure strategies: Gene Therapy, Chemotherapy, and Stem Cell Transplantation (SCT), each compared to ART. Efficacy and cost parameters were varied widely in sensitivity analysis. Outcomes included quality-adjusted life expectancy, lifetime cost, and cost-effectiveness in dollars/quality-adjusted life year ($/QALY) gained. Strategies were deemed cost-effective with incremental cost-effectiveness ratios <$100,000/QALY. For patients on ART, discounted quality-adjusted life expectancy was 16.4 years and lifetime costs were $591,400. Gene Therapy was cost-effective with efficacy of 10%, relapse rate 0.5%/month, and cost $54,000. Chemotherapy was cost-effective with efficacy of 88%, relapse rate 0.5%/month, and cost $12,400/month for 24 months. At $150,000/procedure, SCT was cost-effective with efficacy of 79% and relapse rate 0.5%/month. Moderate efficacy increases and cost reductions made Gene Therapy cost-saving, but substantial efficacy/cost changes were needed to make Chemotherapy or SCT cost-saving. Depending on efficacy, relapse rate, and cost, cure strategies could be cost-effective compared to current ART and potentially cost-saving. These results may help provide performance targets for developing cure strategies for HIV.
登录
查看更多内容
影响因子：
2.1
作者：
Dignan, Fiona L.;Potter, Mike N.;Shaw, Bronwen E.
通讯作者：
Shaw, Bronwen E.
影响因子：
6.2
作者：
Elting, LS;Cantor, SB;Benjamin, RS
通讯作者：
Benjamin, RS
影响因子：
39.2
作者：
Mellors, JW;Munoz, A;Rinaldo, CR
通讯作者：
Rinaldo, CR
影响因子：
6.2
作者：
Havrilesky, Laura J.;Pokrzywinski, Robin;Secord, Angeles Alvarez
通讯作者：
Secord, Angeles Alvarez
影响因子：
4.5
作者：
Leelahavarong, Pattara;Teerawattananon, Yot;Tangcharoensathien, Viroj
通讯作者：
Tangcharoensathien, Viroj