The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle, WA, USA; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
ICAP at Columbia University, New York, NY, USA.
Value Health. 2019 Feb;22(2):194-202. doi: 10.1016/j.jval.2018.09.001. Epub 2018 Nov 2.
To evaluate the cost-effectiveness of financial incentives for human immunodeficiency virus (HIV) viral suppression compared to standard of care.
Mathematical model of 2-year intervention offering financial incentives ($70 quarterly) for viral suppression (<400 copies/ml) based on the HPTN 065 clinical trial with HIV patients in the Bronx, NY and Washington, D.C.
A disease progression model with HIV transmission risk equations was developed following guidelines from the Second Panel on Cost-Effectiveness in Health and Medicine. We used health care sector and societal perspectives, 3% discount rate, and lifetime horizon. Data sources included trial data (baseline N = 16,208 patients), CDC HIV Surveillance data, and published literature. Outcomes were costs (2017 USD), quality-adjusted life years (QALYs), HIV infections prevented, and incremental cost-effectiveness ratio (ICER).
Financial incentives for viral suppression were estimated to be cost-saving from a societal perspective and cost-effective ($49,877/QALY) from a health care sector perspective. Compared to the standard of care, financial incentives gain 0.06 QALYs and lower discounted lifetime costs by $4210 per patient. The model estimates that incentivized patients transmit 9% fewer infections than the standard-of-care patients. In the sensitivity analysis, ICER 95% credible intervals ranged from cost-saving to $501,610/QALY with 72% of simulations being cost-effective using a $150,000/QALY threshold. Modeling results are limited by uncertainty in efficacy from the clinical trial.
Financial incentives, as used in HTPN 065, are estimated to improve quality and length of life, reduce HIV transmissions, and save money from a societal perspective. Financial incentives offer a promising option for enhancing the benefits of medication in the United States.
评估为实现人类免疫缺陷病毒（HIV）病毒抑制提供财务激励与标准护理相比的成本效益。
基于 HPTN 065 临床试验，对纽约布朗克斯和华盛顿特区的 HIV 患者进行为期两年的干预，提供（每季度 70 美元）的财务激励以实现病毒抑制（<400 拷贝/ml），并构建数学模型。
根据第二成本效益卫生保健实用指南，建立了一个具有 HIV 传播风险方程的疾病进展模型。我们采用了医疗保健部门和社会视角、3%贴现率和终身视角。数据来源包括试验数据（基线 N=16208 例患者）、美国疾病控制与预防中心 HIV 监测数据和已发表的文献。结果是成本（2017 年美元）、质量调整生命年（QALY）、预防的 HIV 感染和增量成本效益比（ICER）。
从社会角度来看，为病毒抑制提供财务激励被认为是节省成本的，从医疗保健部门的角度来看，是具有成本效益的（每 QALY 49877 美元）。与标准护理相比，财务激励措施使每位患者获得 0.06 QALY 的收益，并降低了 4210 美元的贴现终身成本。该模型估计，激励患者比标准护理患者的传播感染减少 9%。在敏感性分析中，ICER 的 95%可信区间范围从节省成本到每 QALY 501610 美元不等，其中 72%的模拟结果在使用 150000 美元/QALY 阈值时是具有成本效益的。模型结果受到临床试验疗效不确定性的限制。
从社会角度来看，HPTN 065 中使用的财务激励措施被估计为可以提高质量和寿命，减少 HIV 传播，并节省资金。财务激励措施为增强美国药物治疗的效益提供了一个有前途的选择。
