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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:earlyARTloweredprojected1yearmortalityfrom10.4385,220 with deferred ART to 397,500withearlyART,primarilybecauselifeexpectancyincreased,producinganICERof38,600/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

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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
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