A comparison of the clinical and cost-effectiveness of 3 intervention strategies for AIDS wasting.
OBJECTIVE
To compare oxandrolone (OX) or strength training with nutrition alone (NA) for AIDS wasting.


METHODS
Fifty patients with AIDS; 47 completing the study.


METHODS
Randomization to (1) NA with placebo pills, (2) nutrition with 10 mg of OX administered orally twice a day, or (3) nutrition with progressive resistance training (PRT) for 12 weeks.


METHODS
Midthigh cross-sectional muscle area (CSMA), physical functioning (PF), costs, and cost-effectiveness in dollars/quality-adjusted life-years (dollars/QALYs).


RESULTS
The OX and PRT subjects had increases in CSMA (7.0% +/- 2.5%, P = 0.01; 5.0% +/- 2.0%, P = 0.04, respectively), although these increases did not differ significantly from the NA arm (NA: 1.0% +/- 1.0%; OX vs. NA: P = 0.09; PRT vs. NA: P = 0.26). Only PRT caused significant improvements in PF (mean +/- SE: 10.4 +/- 3.8 points on a 100-point scale) and 7 measures of strength (P values: 0.04 to <0.001). There were no overall differences between groups in PF change. Among patients with impaired baseline PF, however, OX was significantly less effective than NA and PRT was significantly better than NA. All treatments led to increases in protein intake and performance; NA and PRT also increased caloric intake. The institutional costs per subject in this trial were 983 dollars for NA, 3772 dollars for OX, and 3189 dollars for PRT. At a community-based level of intensity, the institutional costs per QALY were 45,000 dollars (range: 42,000 dollars-64,000 dollars) for NA, 147,000 dollars (range: 147,000 dollars-163,000 dollars) for OX, and 31,000 dollars (range: 21,000 dollars-44,000 dollars) for PRT.


CONCLUSIONS
OX and PRT induce similar improvements in body composition, but PRT improves quality of life more than nutrition or OX, particularly among patients with impaired PF. PRT was the most cost-effective intervention, and OX was the least cost-effective intervention.
Shevitz
Abby H
AH
Nutrition Infection Unit, Department of Community Health, Tufts University, Boston, MA 02111, USA. abby.shevitz@tufts.edu
Wilson
Ira B
IB
McDermott
Ann Y
AY
Spiegelman
Donna
D
Skinner
Sarah C
SC
Antonsson
Kristina
K
Layne
Jennifer E
JE
Beaston-Blaakman
Aaron
A
Shepard
Donald S
DS
Gorbach
Sherwood L
SL
D000328:Adult; D045930:Anabolic Agents / Q000191:economics / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001823:Body Composition; D003362:Cost-Benefit Analysis; D004032:Diet / Q000191:economics*; D005260:Female; D019247:HIV Wasting Syndrome / Q000178:diet therapy / Q000191:economics* / Q000628:therapy*; D006304:Health Status; D006801:Humans; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000033:anatomy & histology; D009747:Nutritional Physiological Phenomena; D010074:Oxandrolone / Q000191:economics / Q000627:therapeutic use*; D010806:Physical Education and Training / Q000191:economics*; D011788:Quality of Life; D016896:Treatment Outcome
D045930:Anabolic Agents; D010074:Oxandrolone