A cost analysis of approved antiretroviral strategies in persons with advanced human immunodeficiency virus disease and zidovudine intolerance.
Treatment with zidovudine has been standard therapy for patients with advanced HIV infection, but intolerance is common. Previously, management of intolerance has consisted of symptomatic therapy, dose interruption/discontinuation, and, when appropriate, transfusion. The availability of new antiretroviral agents such as didanosine as well as adjunctive recombinant hematopoietic growth factors makes additional strategies possible for the zidovudine-intolerant patient. Because all of these agents are costly, we evaluated the cost implications of these various strategies for the management of zidovudine-intolerant individuals within a population of persons with advanced HIV disease. We performed a decision analysis using iterative algorithmic models of 1 year of antiretroviral care under various strategies. The real costs providing antiretroviral therapy were estimated by deflating medical center charges by specific Medi-Cal (Medicaid) charge-to-payment ratios. Clinical data were extracted from the medical literature, product package inserts, investigator updates, and personal communications. Sensitivity analysis was used to test the effect of error in the estimation of parameters. The models predict that a strategy of dose interruption and transfusion for zidovudine intolerance will provide an average of 46 weeks of therapy per year to the average patient at a cost of $5,555/year of therapy provided (1991 U.S. dollars). The models predict that a strategy of adding hematopoietic growth factors to the regimen of appropriate patients would increase the average amount of therapy provided to the average patient by 3 weeks (6%) and the costs attributable to therapy by 77% to $9,805/year of therapy provided.(ABSTRACT TRUNCATED AT 250 WORDS)
Bozzette
S A
SA
Department of Medicine, University of California San Diego.
Parker
R
R
Hay
J
J
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000191:economics / Q000628:therapy; D000380:Agranulocytosis / Q000139:chemically induced / Q000628:therapy; D000465:Algorithms; D000740:Anemia / Q000139:chemically induced / Q000628:therapy; D003365:Costs and Cost Analysis; D003661:Decision Support Techniques; D016049:Didanosine / Q000009:adverse effects / Q000627:therapeutic use; D017707:Erythrocyte Transfusion; D004921:Erythropoietin / Q000627:therapeutic use; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics* / Q000628:therapy; D016298:Hematopoietic Cell Growth Factors / Q000627:therapeutic use; D006801:Humans; D010195:Pancreatitis / Q000139:chemically induced; D011788:Quality of Life; D015215:Zidovudine / Q000009:adverse effects / Q000627:therapeutic use*
D016298:Hematopoietic Cell Growth Factors; D004921:Erythropoietin; D016179:Granulocyte Colony-Stimulating Factor; D015215:Zidovudine; D016049:Didanosine