Cost-effectiveness of genotypic antiretroviral resistance testing in HIV-infected patients with treatment failure.
BACKGROUND
Genotypic antiretroviral resistance testing (GRT) in HIV infection with drug resistant virus is recommended to optimize antiretroviral therapy, in particular in patients with virological failure. We estimated the clinical effect, cost and cost-effectiveness of using GRT as compared to expert opinion in patients with antiretroviral treatment failure.


METHODS
We developed a mathematical model of HIV disease to describe disease progression in HIV-infected patients with treatment failure and compared the incremental impact of GRT versus expert opinion to guide antiretroviral therapy. The analysis was conducted from the health care (discount rate 4%) and societal (discount rate 2%) perspective. Outcome measures included life-expectancy, quality-adjusted life-expectancy, health care costs, productivity costs and cost-effectiveness in US Dollars per quality-adjusted life-year (QALY) gained. Clinical and economic data were extracted from the large Swiss HIV Cohort Study and clinical trials.


RESULTS
Patients whose treatment was optimized with GRT versus expert opinion had an increase in discounted life-expectancy and quality-adjusted life-expectancy of three and two weeks, respectively. Health care costs with and without GRT were $US 421,000 and $US 419,000, leading to an incremental cost-effectiveness ratio of $US 35,000 per QALY gained. In the analysis from the societal perspective, GRT versus expert opinion led to an increase in discounted life-expectancy and quality-adjusted life-expectancy of three and four weeks, respectively. Health care costs with and without GRT were $US 551,000 and $US 549,000, respectively. When productivity changes were included in the analysis, GRT was cost-saving.


CONCLUSIONS
GRT for treatment optimization in HIV-infected patients with treatment failure is a cost-effective use of scarce health care resources and beneficial to the society at large.
Sendi
Pedram
P
Division of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Basel, Switzerland. pedram.sendi@unibas.ch
Günthard
Huldrych F
HF
Simcock
Mathew
M
Ledergerber
Bruno
B
Schüpbach
Jörg
J
Battegay
Manuel
M
D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis / Q000191:economics*; D018450:Disease Progression; D024882:Drug Resistance, Viral / Q000235:genetics*; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics; D017048:Health Care Costs; D006801:Humans; D008017:Life Expectancy; D008962:Models, Theoretical; D011788:Quality of Life; D017211:Treatment Failure
D019380:Anti-HIV Agents