Brief Report: Virologic Monitoring Can Be a Cost-Effective Strategy to Diagnose Treatment Failure on First-Line ART.
CD4 count testing is perceived to be an affordable strategy to diagnose treatment failure on first-line antiretroviral therapy. We hypothesize that the superior accuracy of viral load (VL) testing will result in less patients being incorrectly switched to more expensive and toxic second-line regimens. Using data from a drug resistance cohort, we show that CD4 testing is approximately double the cost to make 1 correct regimen switch under certain diagnostic thresholds (CD4 = US $499 vs. VL = US $186 or CD4 = US $3031 vs. VL = US $1828). In line with World Health Organization guidelines, our findings show that VL testing can be both an accurate and cost-effective treatment monitoring strategy.
*Genomics and Population Epidemiology Programme, Wellcome Trust Africa Centre for Population Health, University of KwaZulu-Natal, Durban, South Africa; †Department of Sociology, Minnesota Population Center, University of Minnesota, Minneapolis, MN; ‡Department of Medicine, Center for Infectious Disease and Microbiology Translational Research, University of Minnesota, Minneapolis, MN; §School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa; ‖Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA; and ¶Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom.
Alain M
AM
Vandormael
David R
DR
Boulware
Frank C
FC
Tanser
Till W
TW
Bärnighausen
Katharine E
KE
Stott
Tulio
T
de Oliveira
D000328:Adult; D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D024882:Drug Resistance, Viral; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D008875:Middle Aged; D012680:Sensitivity and Specificity; D017211:Treatment Failure; D019562:Viral Load
D019380:Anti-HIV Agents