Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
Health Economics Unit, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom.
PLoS One. 2018 Jan 23;13(1):e0191465. doi: 10.1371/journal.pone.0191465. eCollection 2018.
Successful antiretroviral therapy (ART) relies on the optimal level of ART adherence to achieve reliable viral suppression, avert HIV drug resistance, and prevent avoidable deaths. It has been shown that there are various groups of people living with HIV at high-risk of non-adherence to ART in sub-Saharan Africa. The objective of this study was to examine the cost effectiveness and value-of-information of directly administered antiretroviral therapy (DAART) versus self-administered ART among people living with HIV, at high risk of non-adherence to ART in sub-Saharan Africa.
A Markov model was developed that describes the transition between HIV stages based on the CD4 count, along with direct costs, quality of life and the mortality rate associated with DAART in comparison with self-administered ART. Data used in the model were derived from the published literature. A health system perspective was employed using a life-time time horizon. Probabilistic sensitivity analysis was performed to determine the impact of parameter uncertainty. Value of information analysis was also conducted. The expected cost of self-administered ART and DAART were $5,200 and $15,500 and the expected QALYs gained were 8.52 and 9.75 respectively, giving an incremental cost effectiveness ratio of $8,400 per QALY gained. The analysis demonstrated that the annual cost DAART needs to be priced below $200 per patient to be cost-effective. The probability that DAART was cost-effective was 1% for a willingness to pay threshold of $5,096 for sub-Saharan Africa. The value of information associated with the cost of DAART and its effectiveness was substantial.
From the perspective of the health care payer in sub-Saharan Africa, DAART cannot be regarded as cost-effective based on current information. The value of information analysis showed that further research will be worthwhile and potentially cost-effective in resolving the uncertainty about whether or not to adopt DAART.
成功的抗逆转录病毒疗法（ART）依赖于最佳的 ART 依从水平，以实现可靠的病毒抑制、避免 HIV 耐药性，并预防可避免的死亡。已经表明，在撒哈拉以南非洲，有各种艾滋病毒感染者群体存在对 ART 依从性差的高风险。本研究旨在探讨直接管理的抗逆转录病毒疗法（DAART）与撒哈拉以南非洲中对 ART 依从性差的高风险艾滋病毒感染者的自我管理 ART 相比的成本效益和信息价值。
建立了一个马尔可夫模型，该模型根据 CD4 计数描述了 HIV 阶段的转换，同时还描述了直接成本、生活质量以及与自我管理 ART 相比的 DAART 相关死亡率。模型中使用的数据来自已发表的文献。采用终生时间范围的卫生系统视角。进行概率敏感性分析以确定参数不确定性的影响。还进行了信息价值分析。自我管理 ART 和 DAART 的预期成本分别为 5200 美元和 15500 美元，预期获得的 QALY 分别为 8.52 和 9.75，增量成本效益比为每获得一个 QALY 增加 8400 美元。分析表明，DAART 的年成本需要低于每个患者 200 美元才能具有成本效益。对于撒哈拉以南非洲地区 5096 美元的支付意愿阈值，DAART 具有成本效益的概率为 1%。与 DAART 的成本及其有效性相关的信息价值很大。
从撒哈拉以南非洲卫生保健支付者的角度来看，根据现有信息，DAART 不能被视为具有成本效益。信息价值分析表明，进一步的研究将是值得的，并可能在解决是否采用 DAART 的不确定性方面具有成本效益。
