Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa.
Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa.
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DOI：
10.1371/journal.pone.0167654
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Revill P
中科院分区：
文献类型：
--
作者：
Phillips AN;Cambiano V;Nakagawa F;Bansi-Matharu L;Sow PS;Ehrenkranz P;Ford D;Mugurungi O;Apollo T;Murungu J;Bangsberg DR;Revill P
以客观衡量艾滋病毒抗逆转录病毒药物依从性为基础的干预措施有可能改善依从性，并使护理得以区分，从而减少高依从性患者的临床就诊。了解为使这种具有一定效力的干预措施具有成本效益而可以考虑的费用的大致上限将是有益的。这些信息可以指导是否根据显示出一定有效性和成本的试验实施干预措施。采用了一个根据津巴布韦进行校准的基于个人的模型，其中包括坚持抗逆转录病毒治疗和对抗逆转录病毒治疗的耐药性的影响，该模型用于模拟基于坚持监测的干预措施对病毒抑制、死亡率、残疾调整生命年和成本的潜在影响。干预的潜在组成效应是：提高抗逆转录病毒治疗的平均依从性，降低抗逆转录病毒治疗停药的风险，降低获得耐药性的风险。我们考虑了病毒载量监测不可用和可用的情况。在前一种情况下，假设护理将根据依从性水平进行区分，那些被证明具有高依从性的诊所就诊次数较少。在后一种情况下，假定护理主要是根据病毒载量水平区分的。达到成本效益所需的最大干预成本是根据每个避免的DALY成本效益阈值500美元来计算的。在缺乏病毒载量监测的情况下，基于依从性监测的干预措施（导致病毒载量< 1000 cps/mL有抗逆转录病毒治疗经验的人的比例持续增加6%）具有成本效益，如果抗逆转录病毒治疗的人均年成本高达50美元，主要是由于差异化护理的成本节约。在病毒载量监测可用性的情况下，当每年花费23- 32美元时，具有类似病毒载量抑制效果的干预具有成本效益，这取决于是否使用依从性干预来减少对病毒载量测量的需求水平。所确定的成本阈值表明，基于依从性监测的干预措施具有明显的空间，可提供人口健康净收益，在有或没有病毒载量监测的情况下具有潜在的成本效益。我们的结果指导了在随机试验中发现的具有健康益处的未来依从性监测干预措施的实施。
Interventions based around objective measurement of adherence to antiretroviral drugs for HIV have potential to improve adherence and to enable differentiation of care such that clinical visits are reduced in those with high adherence. It would be useful to understand the approximate upper limit of cost that could be considered for such interventions of a given effectiveness in order to be cost effective. Such information can guide whether to implement an intervention in the light of a trial showing a certain effectiveness and cost. An individual-based model, calibrated to Zimbabwe, which incorporates effects of adherence and resistance to antiretroviral therapy, was used to model the potential impact of adherence monitoring-based interventions on viral suppression, death rates, disability adjusted life years and costs. Potential component effects of the intervention were: enhanced average adherence when on ART, reduced risk of ART discontinuation, and reduced risk of resistance acquisition. We considered a situation in which viral load monitoring is not available and one in which it is. In the former case, it was assumed that care would be differentiated based on the adherence level, with fewer clinic visits in those demonstrated to have high adherence. In the latter case, care was assumed to be primarily differentiated according to viral load level. The maximum intervention cost required to be cost effective was calculated based on a cost effectiveness threshold of $500 per DALY averted. In the absence of viral load monitoring, an adherence monitoring-based intervention which results in a durable 6% increase in the proportion of ART experienced people with viral load < 1000 cps/mL was cost effective if it cost up to $50 per person-year on ART, mainly driven by the cost savings of differentiation of care. In the presence of viral load monitoring availability, an intervention with a similar effect on viral load suppression was cost-effective when costing $23-$32 per year, depending on whether the adherence intervention is used to reduce the level of need for viral load measurement. The cost thresholds identified suggest that there is clear scope for adherence monitoring-based interventions to provide net population health gain, with potential cost-effective use in situations where viral load monitoring is or is not available. Our results guide the implementation of future adherence monitoring interventions found in randomized trials to have health benefit.
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DOI：
10.1111/tmi.12460
发表时间：
2015-04
期刊：
Tropical medicine & international health : TM & IH
影响因子：
--
作者：
Duncombe C;Rosenblum S;Hellmann N;Holmes C;Wilkinson L;Biot M;Bygrave H;Hoos D;Garnett G
通讯作者：
Garnett G
影响因子：
56.3
作者：
Baernighausen, Till;Chaiyachati, Krisda;Chimbindi, Natsayi;Peoples, Ashleigh;Haberer, Jessica;Newell, Marie-Louise
通讯作者：
Newell, Marie-Louise
DOI：
10.1097/qai.0b013e3181ca48bf
发表时间：
2010-06-01
影响因子：
3.6
作者：
Glass, Tracy R.;Battegay, Manuel;Bucher, Heiner C.
通讯作者：
Bucher, Heiner C.
影响因子：
2.2
作者：
Hassan AS;Nabwera HM;Mwaringa SM;Obonyo CA;Sanders EJ;Rinke de Wit TF;Cane PA;Berkley JA
通讯作者：
Berkley JA
影响因子：
3.8
作者：
Chaiyachati, Krisda H.;Ogbuoji, Osondu;Baernighausen, Till
通讯作者：
Baernighausen, Till