1. Clinical Benefits and Cost-Effectiveness of Laboratory Monitoring Strategies to Guide Antiretroviral Treatment Switching in India
- Author
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Nagalingeswaran Kumarasamy, Eric L. Ross, Kenneth H. Mayer, Rochelle P. Walensky, Timothy P. Flanigan, Ethan D. Borre, Soumya Swaminathan, Kenneth A. Freedberg, and Elena Losina
- Subjects
0301 basic medicine ,Adult ,Male ,medicine.medical_specialty ,Cost effectiveness ,Laboratory monitoring ,Cost-Benefit Analysis ,Immunology ,Human immunodeficiency virus (HIV) ,India ,HIV Infections ,medicine.disease_cause ,Gross domestic product ,03 medical and health sciences ,0302 clinical medicine ,Virology ,Clinical Studies ,Antiretroviral treatment ,Per capita ,Medicine ,Humans ,Computer Simulation ,030212 general & internal medicine ,cost-effectiveness ,health care economics and organizations ,business.industry ,Drug Substitution ,HIV ,laboratory monitoring ,Middle Aged ,Models, Theoretical ,Viral Load ,030112 virology ,3. Good health ,Infectious Diseases ,Anti-Retroviral Agents ,Emergency medicine ,Cohort ,Life expectancy ,RNA, Viral ,Female ,Drug Monitoring ,business - Abstract
Current Indian guidelines recommend twice-annual CD4 testing to monitor first-line antiretroviral therapy (ART), with a plasma HIV RNA test to confirm failure if CD4 declines, which would prompt a switch to second-line ART. We used a mathematical model to assess the clinical benefits and cost-effectiveness of alternative laboratory monitoring strategies in India. We simulated a cohort of HIV-infected patients initiating first-line ART and compared 11 strategies with combinations of CD4 and HIV RNA testing at varying frequencies. We included adaptive strategies that reduce the frequency of tests after 1 year from 6 to 12 months for virologically suppressed patients. We projected life expectancy, time on failed first-line ART, cumulative 10-year HIV transmissions, lifetime cost (2014 US dollars), and incremental cost-effectiveness ratios (ICERs). We defined strategies as cost-effective if their ICER was
- Published
- 2018