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Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa

BACKGROUND: 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 upp...

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Autores principales: Phillips, Andrew N, Cambiano, Valentina, Nakagawa, Fumiyo, Bansi-Matharu, Loveleen, Sow, Papa Salif, Ehrenkranz, Peter, Ford, Deborah, Mugurungi, Owen, Apollo, Tsitsi, Murungu, Joseph, Bangsberg, David R., Revill, Paul
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5157976/
https://www.ncbi.nlm.nih.gov/pubmed/27977702
http://dx.doi.org/10.1371/journal.pone.0167654
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author Phillips, Andrew N
Cambiano, Valentina
Nakagawa, Fumiyo
Bansi-Matharu, Loveleen
Sow, Papa Salif
Ehrenkranz, Peter
Ford, Deborah
Mugurungi, Owen
Apollo, Tsitsi
Murungu, Joseph
Bangsberg, David R.
Revill, Paul
author_facet Phillips, Andrew N
Cambiano, Valentina
Nakagawa, Fumiyo
Bansi-Matharu, Loveleen
Sow, Papa Salif
Ehrenkranz, Peter
Ford, Deborah
Mugurungi, Owen
Apollo, Tsitsi
Murungu, Joseph
Bangsberg, David R.
Revill, Paul
author_sort Phillips, Andrew N
collection PubMed
description BACKGROUND: 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. METHODS: 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. FINDINGS: 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. CONCLUSION: 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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spelling pubmed-51579762016-12-21 Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa Phillips, Andrew N Cambiano, Valentina Nakagawa, Fumiyo Bansi-Matharu, Loveleen Sow, Papa Salif Ehrenkranz, Peter Ford, Deborah Mugurungi, Owen Apollo, Tsitsi Murungu, Joseph Bangsberg, David R. Revill, Paul PLoS One Research Article BACKGROUND: 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. METHODS: 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. FINDINGS: 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. CONCLUSION: 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. Public Library of Science 2016-12-15 /pmc/articles/PMC5157976/ /pubmed/27977702 http://dx.doi.org/10.1371/journal.pone.0167654 Text en © 2016 Phillips et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Phillips, Andrew N
Cambiano, Valentina
Nakagawa, Fumiyo
Bansi-Matharu, Loveleen
Sow, Papa Salif
Ehrenkranz, Peter
Ford, Deborah
Mugurungi, Owen
Apollo, Tsitsi
Murungu, Joseph
Bangsberg, David R.
Revill, Paul
Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa
title Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa
title_full Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa
title_fullStr Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa
title_full_unstemmed Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa
title_short Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa
title_sort cost effectiveness of potential art adherence monitoring interventions in sub-saharan africa
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5157976/
https://www.ncbi.nlm.nih.gov/pubmed/27977702
http://dx.doi.org/10.1371/journal.pone.0167654
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