Cost-effectiveness analysis of using antiretroviral drug resistance testing.
Human immunodeficiency virus (HIV)-infected patients failing highly active antiretroviral therapy (HAART) have a substantially lower chance of clinical success than naive patients given their first antiretroviral therapy. This suggests that HAART failure is a determinant for an increase in the cost of treatment. A review of the literature regarding cost and impact of antiretroviral drug-resistance testing was performed. Examination of existing methods to execute a cost-effectiveness analysis on the use of these tests in clinical practice was also undertaken. The cost of treatment failure in HIV-infected patients has been quantified in several retrospective studies. The cost of care for patients with virological suppression was significantly lower than those with a single virological failure. Moreover, the latter group had lower costs than patients with multiple failures. The result of the cost-effective analysis based on a specific model application using genotypic resistance assays to guide the choice of a subsequent therapy in HIV disease, is cost-effective under a wide range of assumptions regarding effectiveness and costs. The available studies on the cost-effective evaluation of genotypic tests are limited, and the respective studies supply important indications on cost-effective evaluations. Despite its demonstrated benefits, antiretroviral drug resistance testing presents features and limitations that also restrict the cost-effectiveness analysis.
Department of Epidemiology, National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy.
Francesco Nicola
FN
Lauria
Claudio
C
Angeletti
D023241:Antiretroviral Therapy, Highly Active; D003362:Cost-Benefit Analysis; D004279:DNA, Viral; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy; D015497:HIV-1 / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007558:Italy; D008297:Male; D008826:Microbial Sensitivity Tests / Q000191:economics*; D016133:Polymerase Chain Reaction / Q000379:methods; D012680:Sensitivity and Specificity
D004279:DNA, Viral