title: EPICE-HIV: An Epidemiologic Cost-Effectiveness Model for HIV Treatment.
abstract: The goal of this research was to establish a new and innovative framework for cost-effectiveness modeling of HIV-1 treatment, simultaneously considering both clinical and epidemiological outcomes. EPICE-HIV is a multi-paradigm model based on a within-host micro-simulation model for the disease progression of HIV-1 infected individuals and an agent-based sexual contact network (SCN) model for the transmission of HIV-1 infection. It includes HIV-1 viral dynamics, CD4+ T cell infection rates, and pharmacokinetics/pharmacodynamics modeling. Disease progression of HIV-1 infected individuals is driven by the interdependent changes in CD4+ T cell count, changes in plasma HIV-1 RNA, accumulation of resistance mutations and adherence to treatment. The two parts of the model are joined through a per-sexual-act and viral load dependent probability of disease transmission in HIV-discordant couples. Internal validity of the disease progression part of the model is assessed and external validity is demonstrated in comparison to the outcomes observed in the STaR randomized controlled clinical trial. We found that overall adherence to treatment and the resulting pattern of treatment interruptions are key drivers of HIV-1 treatment outcomes. Our model, though largely independent of efficacy data from RCT, was accurate in producing 96-week outcomes, qualitatively and quantitatively comparable to the ones observed in the STaR trial. We demonstrate that multi-paradigm micro-simulation modeling is a promising tool to generate evidence about optimal policy strategies in HIV-1 treatment, including treatment efficacy, HIV-1 transmission, and cost-effectiveness analysis.
authors: Exigo Consultores, Lisbon, Portugal.
authors: Björn
authors: B
authors: Vandewalle
authors: Fundació Lluita contra la SIDA, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors: Josep M
authors: JM
authors: Llibre
authors: Department of Clinical Research and Biostatistics, Côte de Nacre University Hospital, Caen, France.
authors: Jean-Jacques
authors: JJ
authors: Parienti
authors: Regional Infectious Disease Unit, North Manchester General Hospital, Manchester, United Kingdom.
authors: Andrew
authors: A
authors: Ustianowski
authors: Rega Institute for Medical Research, Katholieke Universiteit Leuven, Leuven, Belgium.
authors: Ricardo
authors: R
authors: Camacho
authors: Department of Infection and Population Health, University College London, London, United Kingdom.
authors: Colette
authors: C
authors: Smith
authors: Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors: Alec
authors: A
authors: Miners
authors: Exigo Consultores, Lisbon, Portugal.
authors: Diana
authors: D
authors: Ferreira
authors: Exigo Consultores, Lisbon, Portugal.
authors: Jorge
authors: J
authors: Félix
mesh_terms: D019380:Anti-HIV Agents / Q000191:economics / Q000493:pharmacokinetics / Q000627:therapeutic use*; D015496:CD4-Positive T-Lymphocytes / Q000821:virology; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology / Q000635:transmission; D015497:HIV-1 / Q000187:drug effects* / Q000302:isolation & purification / Q000502:physiology; D006801:Humans; D008954:Models, Biological; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents