The cost effectiveness of combination antiretroviral therapy for HIV disease.
The cost effectiveness of combination antiretroviral therapy for HIV disease.
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DOI：
10.1056/nejm200103153441108
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发表时间：
2001-03-15
影响因子：
158.5
通讯作者：
Goldie, SJ
中科院分区：
文献类型：
--
作者：
Freedberg, KA;Losina, E;Goldie, SJ
背景：在美国，三种或三种以上药物的联合抗逆转录病毒疗法已成为人类免疫缺陷病毒(HIV)感染患者的护理标准。我们评估了三种药物抗逆转录病毒方案的临床效益和成本效果。方法：我们建立了HIV疾病的数学模拟模型，以CD4细胞计数和HIV RNA水平作为疾病进展的预测因子。结果衡量标准包括预期寿命、根据生活质量调整的预期寿命、终身直接医疗成本和每获得一年生活质量调整后的成本效益(以美元计算)。临床数据来自主要的临床试验，包括艾滋病临床试验小组320的研究。费用数据基于全国艾滋病成本和服务利用调查，药品成本从红皮书中获得。结果：与艾滋病临床试验组320研究相似的患者(平均CD4细胞计数，每立方毫米87个)，经生活质量调整后的预期寿命从1.53岁增加到2.91岁，人均终身成本从45,460美元增加到77,300美元，与不治疗相比。与不接受治疗相比，每获得一年生命质量调整后的增量成本为23,000美元。根据来自其他主要研究的其他数据，三种药物治疗的成本-效果比在每获得一年的质量调整后的生命中从13,000美元到23,000美元不等。初始的CD4细胞计数和药物成本是成本、临床收益和成本效益的最重要决定因素。结论：三种抗逆转录病毒药物联合治疗HIV感染是一种成本效益的资源利用。(N Engl J Med 2001；344：824-31)版权所有(C)2001年马萨诸塞州医学会。
Background: Combination antiretroviral therapy with a combination of three or more drugs has become the standard of care for patients with human immunodeficiency virus (HIV) infection in the United States. We estimated the clinical benefits and cost effectiveness of three-drug antiretroviral regimens.Methods: We developed a mathematical simulation model of HIV disease, using the CD4 cell count and HIV RNA level as predictors of the progression of disease. Outcome measures included life expectancy, life expectancy adjusted for the quality of life, lifetime direct medical costs, and cost effectiveness in dollars per quality-adjusted year of life gained. Clinical data were derived from major clinical trials, including the AIDS Clinical Trials Group 320 Study. Data on costs were based on the national AIDS Cost and Services Utilization Survey, with drug costs obtained from the Red Book.Results: For patients similar to those in the AIDS Clinical Trials Group 320 Study (mean CD4 cell count, 87 per cubic millimeter), life expectancy adjusted for the quality of life increased from 1.53 to 2.91 years, and per-person lifetime costs increased from $45,460 to $77,300 with three-drug therapy as compared with no therapy. The incremental cost per quality-adjusted year of life gained, as compared with no therapy, was $23,000. On the basis of additional data from other major studies, the cost-effectiveness ratio for three-drug therapy ranged from $13,000 to $23,000 per quality-adjusted year of life gained. The initial CD4 cell count and drug costs were the most important determinants of costs, clinical benefits, and cost effectiveness.Conclusions: Treatment of HIV infection with a combination of three antiretroviral drugs is a cost-effective use of resources. (N Engl J Med 2001;344:824-31.) Copyright (C) 2001 Massachusetts Medical Society.