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

Publication ,  Journal Article
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 in: HIV Clin Trials
2010

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.

Duke Scholars

Published In

HIV Clin Trials

DOI

ISSN

1528-4336

Publication Date

2010

Volume

11

Issue

5

Start / End Page

248 / 259

Location

England

Related Subject Headings

  • Virology
  • Quality-Adjusted Life Years
  • Models, Immunological
  • Models, Economic
  • Male
  • Life Expectancy
  • Humans
  • HIV Infections
  • HIV
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Sax, P. E., Sloan, C. E., Schackman, B. R., Grant, P. M., Rong, J., Zolopa, A. R., … Cepac US And Actg A5164 Investigators, . (2010). Early antiretroviral therapy for patients with acute aids-related opportunistic infections: a cost-effectiveness analysis of ACTG A5164. HIV Clin Trials, 11(5), 248–259. https://doi.org/10.1310/hct1105-248
Sax, Paul E., Caroline E. Sloan, Bruce R. Schackman, Philip M. Grant, Jian Rong, Andrew R. Zolopa, William Powderly, Elena Losina, Kenneth A. Freedberg, and Kenneth A. Cepac US And Actg A5164 Investigators. “Early antiretroviral therapy for patients with acute aids-related opportunistic infections: a cost-effectiveness analysis of ACTG A5164.HIV Clin Trials 11, no. 5 (2010): 248–59. https://doi.org/10.1310/hct1105-248.
Sax PE, Sloan CE, Schackman BR, Grant PM, Rong J, Zolopa AR, et al. Early antiretroviral therapy for patients with acute aids-related opportunistic infections: a cost-effectiveness analysis of ACTG A5164. HIV Clin Trials. 2010;11(5):248–59.
Sax, Paul E., et al. “Early antiretroviral therapy for patients with acute aids-related opportunistic infections: a cost-effectiveness analysis of ACTG A5164.HIV Clin Trials, vol. 11, no. 5, 2010, pp. 248–59. Pubmed, doi:10.1310/hct1105-248.
Sax PE, Sloan CE, Schackman BR, Grant PM, Rong J, Zolopa AR, Powderly W, Losina E, Freedberg KA, Cepac US And Actg A5164 Investigators. Early antiretroviral therapy for patients with acute aids-related opportunistic infections: a cost-effectiveness analysis of ACTG A5164. HIV Clin Trials. 2010;11(5):248–259.
Journal cover image

Published In

HIV Clin Trials

DOI

ISSN

1528-4336

Publication Date

2010

Volume

11

Issue

5

Start / End Page

248 / 259

Location

England

Related Subject Headings

  • Virology
  • Quality-Adjusted Life Years
  • Models, Immunological
  • Models, Economic
  • Male
  • Life Expectancy
  • Humans
  • HIV Infections
  • HIV
  • Female