肯尼亚女性抗逆转录病毒治疗前艾滋病毒耐药性检测的成本效益分析。
Cost-effectiveness analysis of pre-ART HIV drug resistance testing in Kenyan women.
作者信息
Duarte Horacio A, Babigumira Joseph B, Enns Eva A, Stauffer David C, Shafer Robert W, Beck Ingrid A, Garrison Louis P, Chung Michael H, Frenkel Lisa M, Bendavid Eran
机构信息
Department of Pediatrics, Division of Infectious Diseases, University of Washington, Seattle, WA, United States.
Seattle Children's Research Institute, Seattle, WA, United States.
出版信息
EClinicalMedicine. 2020 May 22;22:100355. doi: 10.1016/j.eclinm.2020.100355. eCollection 2020 May.
BACKGROUND
The prevalence of pre-treatment drug resistance (PDR) to non-nucleoside reverse-transcriptase inhibitor (NNRTI) agents is increasing in sub-Saharan Africa, which may decrease the effectiveness of efavirenz-based antiretroviral therapy (ART) programs. However, due to recent safety concerns, there has been hesitancy to replace efavirenz-based ART with dolutegravir in women of reproductive potential. Our objective was to evaluate whether PDR testing for women not initiating dolutegravir-based ART would be a cost-effective strategy to address the challenges posed by PDR.
METHODS
We developed an HIV drug resistance model that simulates the emergence and transmission of resistance mutations, calibrated to the Kenyan epidemic. We modeled three care strategies for PDR testing among women not initiating dolutegravir-based ART: no PDR testing, PDR testing with a low-cost point mutation assay, known as oligonucleotide ligation assay (OLA), and PDR testing with consensus sequencing. Using a health sector perspective, this model was used to evaluate the health outcomes, lifetime costs, and cost-effectiveness under each strategy over a 15-year time horizon starting in 2019.
FINDINGS
OLA and CS PDR testing were projected to have incremental cost-effectiveness ratios (ICER) of $10,741/QALY gained and $134,396/QALY gained, respectively, which are not cost-effective by national income standards. Viral suppression rates among women at 12 months after ART initiation were 87·8%, 89·0%, and 89·3% with no testing, OLA testing, and CS testing, respectively. PDR testing with OLA and CS were associated with a 0.5% and 0.6% reduction in incidence rate compared to no PDR testing. Initial PDR prevalence among women was 13.1% in 2019. By 2034, this prevalence was 17·6%, 17·4%, and 17·3% with no testing, OLA testing, and CS testing, respectively.
INTERPRETATION
PDR testing for women is unlikely to be cost-effective in Kenya whether one uses a low-cost assay, such as OLA, or consensus sequencing.
FUNDING
National Institutes of Health, Gilead Sciences.
背景
在撒哈拉以南非洲地区，对非核苷类逆转录酶抑制剂（NNRTI）药物的治疗前耐药（PDR）患病率正在上升，这可能会降低基于依非韦伦的抗逆转录病毒治疗（ART）方案的有效性。然而，由于近期的安全性担忧，对于有生育潜力的女性，人们在是否用多替拉韦替代基于依非韦伦的ART治疗上犹豫不决。我们的目标是评估对未开始基于多替拉韦的ART治疗的女性进行PDR检测是否是应对PDR带来挑战的一种具有成本效益的策略。
方法
我们开发了一个HIV耐药模型，该模型模拟耐药突变的出现和传播，并根据肯尼亚的疫情进行校准。我们为未开始基于多替拉韦的ART治疗的女性的PDR检测模拟了三种护理策略：不进行PDR检测、使用低成本点突变检测方法（即寡核苷酸连接检测法，OLA）进行PDR检测以及进行一致性测序的PDR检测。从卫生部门的角度出发，该模型用于评估从2019年开始的15年时间范围内每种策略下的健康结果、终身成本和成本效益。
研究结果
预计OLA和一致性测序PDR检测的增量成本效益比（ICER）分别为每获得一个质量调整生命年（QALY）增加10,741美元和134,396美元，按照国民收入标准，这两种检测都不具有成本效益。在开始ART治疗12个月后，未进行检测、OLA检测和一致性测序检测的女性的病毒抑制率分别为87.8%、89.0%和89.3%。与不进行PDR检测相比，使用OLA和一致性测序进行PDR检测的发病率分别降低了0.5%和0.6%。2019年女性的初始PDR患病率为13.1%。到2034年，不进行检测、OLA检测和一致性测序检测时，该患病率分别为17.6%、17.4%和17.3%。
解读
在肯尼亚，无论使用低成本检测方法（如OLA）还是一致性测序，对女性进行PDR检测都不太可能具有成本效益。
资助
美国国立卫生研究院、吉利德科学公司。
Zotero 插件