title: Cost-effectiveness of adherence interventions for highly active antiretroviral therapy: a systematic review.
abstract: OBJECTIVE
  The objective of this systematic review was to evaluate the cost-effectiveness of interventions aiming to increase the adherence to highly active antiretroviral therapy (HAART) in HIV-infected patients in developed countries (WHO stratum A).
  
  
  METHODS
  A systematic search for comparative health economic studies was conducted in the following databases: EMBASE, MEDLINE, NHS Economic Evaluation Database, CINAHL, HEED, and EconLit. The identified publications were selected by two reviewers independently according to predefined inclusion and exclusion criteria. Furthermore, these were evaluated according to a standardized checklist and finally extracted, analyzed, and summarized.
  
  
  RESULTS
  After reviewing the abstracts and full texts four relevant studies were identified. Different educational programs were compared as well as the Directly Observed Therapy (DOT). A critical aspect to be considered in particular was the poor transparency of the cost data. In three cost-utility analyses the costs per quality-adjusted life-year (QALY) in the baseline scenario were each under USD 15,000. The sensitivity analyses with a presumed maximum threshold of USD 50,000/QALY showed a predominantly cost-effective result. In one study that examined DOT the costs add up to over USD 150,000/QALY.
  
  
  CONCLUSIONS
  It seems that adherence interventions for HAART in HIV-infected patients can be cost-effective. Nevertheless, the quality of the included studies is deficient and only a few of the possible adherence interventions are taken into consideration. A final assessment of the cost-effectiveness of adherence interventions in general is, therefore, not possible.
authors.affiliation: Institute for Research in Operative Medicine, Witten/Herdecke University, Cologne,Germany. Tim.Mathes@uni-wh.de
authors.forename: Tim
authors.initials: T
authors.lastname: Mathes
authors.forename: Dawid
authors.initials: D
authors.lastname: Pieper
authors.forename: Sunya-Lee
authors.initials: SL
authors.lastname: Antoine
authors.forename: Michaela
authors.initials: M
authors.lastname: Eikermann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D057189:Checklist; D003362:Cost-Benefit Analysis; D019049:Developed Countries; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D055815:Young Adult