An economic evaluation of treatments for HIV-associated facial lipoatrophy: a cost-utility analysis.
BACKGROUND
HIV-associated facial lipoatrophy (FLA) is a stigmatizing hallmark for persons living with HIV [PLWH], and can lead to poor social functioning, social isolation, and reduced labour force participation. Treatments for this condition are prohibitively expensive and are not publicly insured in the Province of Ontario, Canada. Information gleaned from an economic evaluation of treatments for FLA could inform policy decision making concerning coverage.


METHODS
Decision-analytic techniques were used to estimate the lifetime incremental costs and quality-adjusted life years (QALYs) gained from use of either Poly-l-lactic acid or Polyalkylimide gel from the perspectives of society and the Ontario Ministry of Health. Disease progression probabilities and utilities were derived from the literature. Costs were obtained through interviews with product distributors and physicians who perform these treatments. Costs were valued in 2009 Canadian Dollars. Costs and outcomes were discounted annually at 3%.


RESULTS
Treatments using Polyalkylimide gel exhibit such a cost advantage over those using Poly-l-lactic acid that they more than compensate for the health-related quality of life advantages of Poly-l-lactic acid. From a Ministry of Health perspective, the incremental cost-utility ratios for Polyalkylimide gel or Poly-l-lactic acid compared to no treatment were $45,457 CAD or $57,352 CAD per QALY, respectively, $1.00 CAD = $0.876 USD). From a societal perspective the equivalent ratios were $48,583 CAD and $66,608 CAD respectively. These findings were not altered in the sensitivity analyses.


CONCLUSIONS
FLA treatments for PLWH enhance QALYs and meet conventional cost-utility thresholds. The incremental cost per QALY for Polyalkylimide gel was lower than that for Poly-l-lactic acid.
Peyasantiwong
Sirianong
S
Department of Health Policy, Management and Evaluation, Faculty of Medicine, 155 College Street 4th Floor, University of Toronto, Toronto, Ontario M5T 3M6, Canada.
Loutfy
Mona R
MR
Laporte
Audrey
A
Coyte
Peter C
PC
D000273:Adipose Tissue / Q000473:pathology*; D001284:Atrophy / Q000191:economics* / Q000601:surgery*; D003362:Cost-Benefit Analysis; D005145:Face / Q000473:pathology*; D039682:HIV-Associated Lipodystrophy Syndrome / Q000191:economics* / Q000601:surgery*; D006801:Humans; D019344:Lactic Acid / Q000627:therapeutic use; D008875:Middle Aged; D009864:Ontario; D011091:Polyesters; D011108:Polymers / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D013518:Surgery, Plastic / Q000379:methods; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; C033616:poly(lactide)