Clinical impact and cost-effectiveness of making third-line antiretroviral therapy available in sub-Saharan Africa: A model-based analysis in Côte d’Ivoire
Identifieur interne : 001925 ( Pmc/Corpus ); précédent : 001924; suivant : 001926Clinical impact and cost-effectiveness of making third-line antiretroviral therapy available in sub-Saharan Africa: A model-based analysis in Côte d’Ivoire
Auteurs : Eric N. Ouattara ; Eric L. Ross ; Yazdan Yazdanpanah ; Angela Y. Wong ; Marion Robine ; Elena Losina ; Raoul Moh ; Rochelle P. Walensky ; Christine Danel ; A. David Paltiel ; Serge P. Eholié ; Kenneth A. Freedberg ; Xavier AnglaretSource :
- Journal of acquired immune deficiency syndromes (1999) [ 1525-4135 ] ; 2014.
Abstract
In sub-Saharan Africa, HIV-infected adults who fail 2nd-line antiretroviral therapy (ART) often do not have access to 3rd-line ART. We examined the clinical impact and cost-effectiveness of making 3rd-line ART available in Côte d’Ivoire.
We used a simulation model to compare four strategies following
2nd-line ART failure: continue 2nd-line ART
[C-ART2]; continue 2nd-line ART with an adherence reinforcement
intervention [AR-ART2]; immediate switch to 3rd-line ART
[IS-ART3]; and continue 2nd-line ART with adherence
reinforcement, switching patients with persistent failure to
3rd-line ART [AR-ART3]. Third-line ART consisted of a
boosted-darunavir plus raltegravir-based regimen. Primary outcomes were
10-year survival and lifetime incremental cost effectiveness ratios (ICERs),
in $/year of life saved (YLS). ICERs below $3,585 (3 times the country
Ten-year survival was 6.0% with C-ART2, 17.0% with AR-ART2, 35.4% with IS-ART3, and 37.2% with AR-ART3. AR-ART2 was cost-effective ($1,100/YLS). AR-ART3 had an ICER of $3,600/YLS and became cost-effective if the cost of 3rd-line ART decreased by <1%. IS-ART3 was less effective and more costly than AR-ART3. Results were robust to wide variations in the efficacy of 3rd-line ART and of the adherence reinforcement, as well as in the cost 2nd-line ART.
Access to 3rd-line ART combined with an intense adherence reinforcement phase, used as a tool to distinguish between patients who can still benefit from their current 2nd-line regimen and those who truly need 3rd-line ART would provide substantial survival benefits. With minor decreases in drug costs, this strategy would be cost-effective.
Url:
DOI: 10.1097/QAI.0000000000000166
PubMed: 24732870
PubMed Central: 4146647
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Clinical impact and cost-effectiveness of making third-line
antiretroviral therapy available in sub-Saharan Africa: A model-based analysis
in Côte d’Ivoire</title><author><name sortKey="Ouattara, Eric N" sort="Ouattara, Eric N" uniqKey="Ouattara E" first="Eric N." last="Ouattara">Eric N. Ouattara</name></author><author><name sortKey="Ross, Eric L" sort="Ross, Eric L" uniqKey="Ross E" first="Eric L." last="Ross">Eric L. Ross</name></author><author><name sortKey="Yazdanpanah, Yazdan" sort="Yazdanpanah, Yazdan" uniqKey="Yazdanpanah Y" first="Yazdan" last="Yazdanpanah">Yazdan Yazdanpanah</name></author><author><name sortKey="Wong, Angela Y" sort="Wong, Angela Y" uniqKey="Wong A" first="Angela Y." last="Wong">Angela Y. Wong</name></author><author><name sortKey="Robine, Marion" sort="Robine, Marion" uniqKey="Robine M" first="Marion" last="Robine">Marion Robine</name></author><author><name sortKey="Losina, Elena" sort="Losina, Elena" uniqKey="Losina E" first="Elena" last="Losina">Elena Losina</name></author><author><name sortKey="Moh, Raoul" sort="Moh, Raoul" uniqKey="Moh R" first="Raoul" last="Moh">Raoul Moh</name></author><author><name sortKey="Walensky, Rochelle P" sort="Walensky, Rochelle P" uniqKey="Walensky R" first="Rochelle P." last="Walensky">Rochelle P. Walensky</name></author><author><name sortKey="Danel, Christine" sort="Danel, Christine" uniqKey="Danel C" first="Christine" last="Danel">Christine Danel</name></author><author><name sortKey="Paltiel, A David" sort="Paltiel, A David" uniqKey="Paltiel A" first="A. David" last="Paltiel">A. David Paltiel</name></author><author><name sortKey="Eholie, Serge P" sort="Eholie, Serge P" uniqKey="Eholie S" first="Serge P." last="Eholié">Serge P. Eholié</name></author><author><name sortKey="Freedberg, Kenneth A" sort="Freedberg, Kenneth A" uniqKey="Freedberg K" first="Kenneth A." last="Freedberg">Kenneth A. Freedberg</name></author><author><name sortKey="Anglaret, Xavier" sort="Anglaret, Xavier" uniqKey="Anglaret X" first="Xavier" last="Anglaret">Xavier Anglaret</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24732870</idno><idno type="pmc">4146647</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4146647</idno><idno type="RBID">PMC:4146647</idno><idno type="doi">10.1097/QAI.0000000000000166</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">001925</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001925</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Clinical impact and cost-effectiveness of making third-line
antiretroviral therapy available in sub-Saharan Africa: A model-based analysis
in Côte d’Ivoire</title><author><name sortKey="Ouattara, Eric N" sort="Ouattara, Eric N" uniqKey="Ouattara E" first="Eric N." last="Ouattara">Eric N. Ouattara</name></author><author><name sortKey="Ross, Eric L" sort="Ross, Eric L" uniqKey="Ross E" first="Eric L." last="Ross">Eric L. Ross</name></author><author><name sortKey="Yazdanpanah, Yazdan" sort="Yazdanpanah, Yazdan" uniqKey="Yazdanpanah Y" first="Yazdan" last="Yazdanpanah">Yazdan Yazdanpanah</name></author><author><name sortKey="Wong, Angela Y" sort="Wong, Angela Y" uniqKey="Wong A" first="Angela Y." last="Wong">Angela Y. Wong</name></author><author><name sortKey="Robine, Marion" sort="Robine, Marion" uniqKey="Robine M" first="Marion" last="Robine">Marion Robine</name></author><author><name sortKey="Losina, Elena" sort="Losina, Elena" uniqKey="Losina E" first="Elena" last="Losina">Elena Losina</name></author><author><name sortKey="Moh, Raoul" sort="Moh, Raoul" uniqKey="Moh R" first="Raoul" last="Moh">Raoul Moh</name></author><author><name sortKey="Walensky, Rochelle P" sort="Walensky, Rochelle P" uniqKey="Walensky R" first="Rochelle P." last="Walensky">Rochelle P. Walensky</name></author><author><name sortKey="Danel, Christine" sort="Danel, Christine" uniqKey="Danel C" first="Christine" last="Danel">Christine Danel</name></author><author><name sortKey="Paltiel, A David" sort="Paltiel, A David" uniqKey="Paltiel A" first="A. David" last="Paltiel">A. David Paltiel</name></author><author><name sortKey="Eholie, Serge P" sort="Eholie, Serge P" uniqKey="Eholie S" first="Serge P." last="Eholié">Serge P. Eholié</name></author><author><name sortKey="Freedberg, Kenneth A" sort="Freedberg, Kenneth A" uniqKey="Freedberg K" first="Kenneth A." last="Freedberg">Kenneth A. Freedberg</name></author><author><name sortKey="Anglaret, Xavier" sort="Anglaret, Xavier" uniqKey="Anglaret X" first="Xavier" last="Anglaret">Xavier Anglaret</name></author></analytic><series><title level="j">Journal of acquired immune deficiency syndromes (1999)</title><idno type="ISSN">1525-4135</idno><idno type="eISSN">1944-7884</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objective</title><p id="P1">In sub-Saharan Africa, HIV-infected adults who fail
2<sup>nd</sup>-line antiretroviral therapy (ART) often do not have access to
3<sup>rd</sup>-line ART. We examined the clinical impact and
cost-effectiveness of making 3<sup>rd</sup>-line ART available in
Côte d’Ivoire.</p></sec><sec id="S2"><title>Methods</title><p id="P2">We used a simulation model to compare four strategies following
2<sup>nd</sup>-line ART failure: continue 2<sup>nd</sup>-line ART
[C-ART2]; continue 2<sup>nd</sup>-line ART with an adherence reinforcement
intervention [AR-ART2]; immediate switch to 3<sup>rd</sup>-line ART
[IS-ART3]; and continue 2<sup>nd</sup>-line ART with adherence
reinforcement, switching patients with persistent failure to
3<sup>rd</sup>-line ART [AR-ART3]. Third-line ART consisted of a
boosted-darunavir plus raltegravir-based regimen. Primary outcomes were
10-year survival and lifetime incremental cost effectiveness ratios (ICERs),
in $/year of life saved (YLS). ICERs below $3,585 (3 times the country
<italic>per capita</italic> GDP) were considered cost-effective.</p></sec><sec id="S3"><title>Results</title><p id="P3">Ten-year survival was 6.0% with C-ART2, 17.0% with
AR-ART2, 35.4% with IS-ART3, and 37.2% with AR-ART3. AR-ART2
was cost-effective ($1,100/YLS). AR-ART3 had an ICER of $3,600/YLS and
became cost-effective if the cost of 3<sup>rd</sup>-line ART decreased by
<1%. IS-ART3 was less effective and more costly than
AR-ART3. Results were robust to wide variations in the efficacy of
3<sup>rd</sup>-line ART and of the adherence reinforcement, as well as
in the cost 2<sup>nd</sup>-line ART.</p></sec><sec id="S4"><title>Conclusion</title><p id="P4">Access to 3<sup>rd</sup>-line ART combined with an intense adherence
reinforcement phase, used as a tool to distinguish between patients who can
still benefit from their current 2<sup>nd</sup>-line regimen and those who
truly need 3<sup>rd</sup>-line ART would provide substantial survival
benefits. With minor decreases in drug costs, this strategy would be
cost-effective.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">100892005</journal-id><journal-id journal-id-type="pubmed-jr-id">21821</journal-id><journal-id journal-id-type="nlm-ta">J Acquir Immune Defic Syndr</journal-id><journal-id journal-id-type="iso-abbrev">J. Acquir. Immune Defic. Syndr.</journal-id><journal-title-group><journal-title>Journal of acquired immune deficiency syndromes (1999)</journal-title></journal-title-group><issn pub-type="ppub">1525-4135</issn><issn pub-type="epub">1944-7884</issn></journal-meta><article-meta><article-id pub-id-type="pmid">24732870</article-id><article-id pub-id-type="pmc">4146647</article-id><article-id pub-id-type="doi">10.1097/QAI.0000000000000166</article-id><article-id pub-id-type="manuscript">NIHMS584195</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Clinical impact and cost-effectiveness of making third-line
antiretroviral therapy available in sub-Saharan Africa: A model-based analysis
in Côte d’Ivoire</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Ouattara</surname><given-names>Eric N.</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Ross</surname><given-names>Eric L.</given-names></name><degrees>BA</degrees></contrib><contrib contrib-type="author"><name><surname>Yazdanpanah</surname><given-names>Yazdan</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Wong</surname><given-names>Angela Y.</given-names></name><degrees>BS</degrees></contrib><contrib contrib-type="author"><name><surname>Robine</surname><given-names>Marion</given-names></name><degrees>BS</degrees></contrib><contrib contrib-type="author"><name><surname>Losina</surname><given-names>Elena</given-names></name><degrees>PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Moh</surname><given-names>Raoul</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Walensky</surname><given-names>Rochelle P.</given-names></name><degrees>MD, MPH</degrees></contrib><contrib contrib-type="author"><name><surname>Danel</surname><given-names>Christine</given-names></name><degrees>MD, PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Paltiel</surname><given-names>A. David</given-names></name><degrees>PhD</degrees></contrib><contrib contrib-type="author"><name><surname>Eholié</surname><given-names>Serge P.</given-names></name><degrees>MD, MSc</degrees></contrib><contrib contrib-type="author"><name><surname>Freedberg</surname><given-names>Kenneth A.</given-names></name><degrees>MD, MSc</degrees></contrib><contrib contrib-type="author"><name><surname>Anglaret</surname><given-names>Xavier</given-names></name><degrees>MD, PhD</degrees></contrib><aff id="A1">Inserm, Centre Inserm 897, Bordeaux, France (EO, CD, XA); Univ. Bordeaux, ISPED, Bordeaux, France (EO, CD, XA); The Programme PAC-CI/ANRS research site, CHU de Treichville, Abidjan, Côte d’Ivoire (EO, RM, CD, SPE, XA); The Department of Infectious and Tropical Diseases, Treichville University Hospital, Abidjan, Côte d'Ivoire (SE, RM); The Department of Infectious and Tropical Diseases, Bichat-Claude Bernard University Hospital, Paris, France (YY); the Inserm, Equipe Atip/Avenir Inserm U738, Paris, France (YY); The Divisions of Infectious Disease (RPW, KAF) and General Medicine (RPW, EL, ER, MR, KAF, AYW), and the Medical Practice Evaluation Center, Department of Medicine, Massachusetts General Hospital; the Division of Infectious Disease (RPW) and the Department of Orthopedics (EL), Brigham and Women’s Hospital; the Harvard University Center for AIDS Research (EL, RPW, KAF); Harvard Medical School (EL, RPW, KAF); the Departments of Biostatistics (EL) and Epidemiology (KAF), Boston University School of Public Health; and the Department of Health Policy and Management, Harvard School of Public Health (KAF); all in Boston, MA, USA, and the Department of Epidemiology and Public Health, Yale School of Public Health, New Haven, CT, USA (ADP).</aff></contrib-group><author-notes><corresp id="cor1"><bold>Corresponding author</bold>: Eric Ouattara, MD, MPH,
Programme PACCI, CHU de Treichville, 18 BP 1954, Abidjan 18, Côte
d’Ivoire, Phone: +225 21 75 59 60, Fax: +225 21 24 90 69,
<email>Eric.Ouattara@isped.u-bordeaux2.fr</email></corresp></author-notes><pub-date pub-type="nihms-submitted"><day>15</day><month>5</month><year>2014</year></pub-date><pub-date pub-type="ppub"><day>1</day><month>7</month><year>2014</year></pub-date><pub-date pub-type="pmc-release"><day>01</day><month>7</month><year>2015</year></pub-date><volume>66</volume><issue>3</issue><fpage>294</fpage><lpage>302</lpage><pmc-comment>elocation-id from pubmed: 10.1097/QAI.0000000000000166</pmc-comment>
<abstract><sec id="S1"><title>Objective</title><p id="P1">In sub-Saharan Africa, HIV-infected adults who fail
2<sup>nd</sup>-line antiretroviral therapy (ART) often do not have access to
3<sup>rd</sup>-line ART. We examined the clinical impact and
cost-effectiveness of making 3<sup>rd</sup>-line ART available in
Côte d’Ivoire.</p></sec><sec id="S2"><title>Methods</title><p id="P2">We used a simulation model to compare four strategies following
2<sup>nd</sup>-line ART failure: continue 2<sup>nd</sup>-line ART
[C-ART2]; continue 2<sup>nd</sup>-line ART with an adherence reinforcement
intervention [AR-ART2]; immediate switch to 3<sup>rd</sup>-line ART
[IS-ART3]; and continue 2<sup>nd</sup>-line ART with adherence
reinforcement, switching patients with persistent failure to
3<sup>rd</sup>-line ART [AR-ART3]. Third-line ART consisted of a
boosted-darunavir plus raltegravir-based regimen. Primary outcomes were
10-year survival and lifetime incremental cost effectiveness ratios (ICERs),
in $/year of life saved (YLS). ICERs below $3,585 (3 times the country
<italic>per capita</italic> GDP) were considered cost-effective.</p></sec><sec id="S3"><title>Results</title><p id="P3">Ten-year survival was 6.0% with C-ART2, 17.0% with
AR-ART2, 35.4% with IS-ART3, and 37.2% with AR-ART3. AR-ART2
was cost-effective ($1,100/YLS). AR-ART3 had an ICER of $3,600/YLS and
became cost-effective if the cost of 3<sup>rd</sup>-line ART decreased by
<1%. IS-ART3 was less effective and more costly than
AR-ART3. Results were robust to wide variations in the efficacy of
3<sup>rd</sup>-line ART and of the adherence reinforcement, as well as
in the cost 2<sup>nd</sup>-line ART.</p></sec><sec id="S4"><title>Conclusion</title><p id="P4">Access to 3<sup>rd</sup>-line ART combined with an intense adherence
reinforcement phase, used as a tool to distinguish between patients who can
still benefit from their current 2<sup>nd</sup>-line regimen and those who
truly need 3<sup>rd</sup>-line ART would provide substantial survival
benefits. With minor decreases in drug costs, this strategy would be
cost-effective.</p></sec></abstract></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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