Early antiretroviral therapy for patients with acute aids-related opportunistic infections: a cost-effectiveness analysis of ACTG A5164.

Journal Article (Journal Article)

PURPOSE: ACTG A5164 demonstrated that early antiretroviral therapy (ART) in HIV-infected patients with acute opportunistic infections (OIs) reduced death and AIDS progression compared to ART initiation 1 month later. We project the life expectancies, costs, and incremental cost-effectiveness ratios (ICERs) of these strategies. METHOD: using an HIV simulation model, we compared 2 strategies for patients with acute OIs: (1) an intervention to deliver early ART, and (2) deferred ART. Parameters from ACTG A5164 included initial mean CD4 count (47/microL), linkage to outpatient care (87%), and immune reconstitution inflammatory syndrome 1 month after ART initiation (7%). The estimated intervention cost was $1,650/patient. RESULTS: early ART lowered projected 1-year mortality from 10.4% to 8.2% and increased life expectancy from 10.07 to 10.39 quality-adjusted life-years (QALYs). Lifetime costs increased from $385,220 with deferred ART to $397,500 with early ART, primarily because life expectancy increased, producing an ICER of $38,600/QALY. Results were most sensitive to increased intervention cost and decreased virologic efficacy in the early ART strategy. CONCLUSIONS: an intervention to initiate ART early in patients with acute OIs improves survival and meets US cost-effectiveness thresholds. Programs should be developed to implement this strategy at sites where HIV-infected patients present with OIs.

Full Text

Duke Authors

Cited Authors

  • Sax, PE; Sloan, CE; Schackman, BR; Grant, PM; Rong, J; Zolopa, AR; Powderly, W; Losina, E; Freedberg, KA; Cepac US And Actg A5164 Investigators,

Published Date

  • September 2010

Published In

Volume / Issue

  • 11 / 5

Start / End Page

  • 248 - 259

PubMed ID

  • 21126955

Pubmed Central ID

  • PMC3183461

International Standard Serial Number (ISSN)

  • 1528-4336

Digital Object Identifier (DOI)

  • 10.1310/hct1105-248

Language

  • eng

Conference Location

  • England