title: Cost-effectiveness of an intervention to improve adherence to antiretroviral therapy in HIV-infected patients.
abstract: Adherence to antiretroviral medications has been shown to be an important factor in predicting viral suppression and clinical outcomes. The objective of this analysis was to assess the cost-effectiveness of a nursing intervention on antiretroviral adherence using data from a randomized controlled clinical trial as input to a computer-based simulation model of HIV disease. For a cohort of HIV-infected patients similar to those in the clinical trial (mean initial CD4 count of 319 cells/mm), implementing the nursing intervention in addition to standard care yielded a 63% increase in virologic suppression at 48 weeks. This produced increases in expected survival (from 94.5 to 100.9 quality-adjusted life months) and estimated discounted direct lifetime medical costs ($253,800 to $261,300). The incremental cost-effectiveness ratio for the intervention was $14,100 per quality-adjusted life year gained compared with standard care. Adherence interventions with modest effectiveness are likely to provide long-term survival benefit to patients and to be cost-effective compared with other uses of HIV care funds.
authors.affiliation: Divisions of General Medicine and Infectious Diseases and the Partners AIDS Research Center, Massachusetts General Hospital, Boston, MA 02114, USA. kfreedberg@partners.org
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Hirschhorn
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Schackman
authors.forename: Lindsey L
authors.initials: LL
authors.lastname: Wolf
authors.forename: Lindsay A
authors.initials: LA
authors.lastname: Martin
authors.forename: Milton C
authors.initials: MC
authors.lastname: Weinstein
authors.forename: Susan
authors.initials: S
authors.lastname: Goldin
authors.forename: A David
authors.initials: AD
authors.lastname: Paltiel
authors.forename: Carol
authors.initials: C
authors.lastname: Katz
authors.forename: Sue J
authors.initials: SJ
authors.lastname: Goldie
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000451:nursing*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010349:Patient Compliance; D012680:Sensitivity and Specificity
chemical_list: D019380:Anti-HIV Agents