African Evaluation Database

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5167

Source

Scopus

Electronic ID

2-s2.0-84873051514

Authors

Levison J.H., Wood R., Scott C.A., Ciaranello A.L., Martinson N.A., Rusu C., Losina E., Freedberg K.A., Walensky R.P.

Title

The clinical and economic impact of genotype testing at first-line antiretroviral therapy failure for HIV-infected patients in South Africa

Publication Year

2013

Source Title

Clinical Infectious Diseases

Volume

Issue

Citations

DOI

10.1093/cid/cis887

URL

https://www.scopus.com/inward/record.uri?eid=2-s2.0-84873051514&partnerID=40&md5=4df5375cbb012f15a99c8a0617843992

Affiliations

Division of Infectious Diseases, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, United States; Division of General Medicine, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, United States; Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, United States; Desmond Tutu HIV Center, Department of Medicine, University of Cape Town, South Africa; Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Johns Hopkins University School of Medicine, Baltimore, MD, United States; Departments of Biostatistics, United States; Departments of Epidemiology, Boston University, School of Public Health, United States; Division of Infectious Disease, United States; Department of Orthopedic Surgery, Brigham and Women's Hospital, United States; Harvard Center for AIDS Research, Harvard University, United States; Harvard Medical School, Boston, MA, United States

Authors with Affiliations

Levison, J.H., Division of Infectious Diseases, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, United States, Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, United States, Division of Infectious Disease, United States, Harvard Medical School, Boston, MA, United States; Wood, R., Desmond Tutu HIV Center, Department of Medicine, University of Cape Town, South Africa; Scott, C.A., Division of General Medicine, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, United States; Ciaranello, A.L., Division of Infectious Diseases, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, United States, Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, United States, Harvard Medical School, Boston, MA, United States; Martinson, N.A., Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Rusu, C., Division of General Medicine, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, United States, Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, United States; Losina, E., Division of General Medicine, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, United States, Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, United States, Departments of Biostatistics, United States, Department of Orthopedic Surgery, Brigham and Women's Hospital, United States, Harvard Center for AIDS Research, Harvard University, United States, Harvard Medical School, Boston, MA, United States; Freedberg, K.A., Division of Infectious Diseases, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, United States, Division of General Medicine, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, United States, Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, United States, Departments of Epidemiology, Boston University, School of Public Health, United States, Harvard Center for AIDS Research, Harvard University, United States, Harvard Medical School, Boston, MA, United States; Walensky, R.P., Division of Infectious Diseases, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, United States, Division of General Medicine, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, United States, Medical Practice Evaluation Center, Massachusetts General Hospital, 50 Staniford St, Boston, MA 02114, United States, Division of Infectious Disease, United States, Harvard Center for AIDS Research, Harvard University, United States, Harvard Medical School, Boston, MA, United States

Abstract

Background. In resource-limited settings, genotype testing at virologic failure on first-line antiretroviral therapy (ART) may identify patients with wild-type (WT) virus. After adherence counseling, these patients may safely and effectively continue first-line ART, thereby delaying more expensive second-line ART.Methods. We used the Cost-Effectiveness of Preventing AIDS Complications International model of human immunodeficiency virus (HIV) disease to simulate a South African cohort of HIV-infected adults at first-line ART failure. Two strategies were examined: no genotype vs genotype, assuming availability of protease inhibitor-based second-line ART. Model inputs at first-line ART failure were mean age 38 years, mean CD4 173/μL, and WT virus prevalence 20%; genotype cost was $300 per test and delay to results, 3 months. Outcomes included life expectancy, per-person costs (2010 US dollars), and incremental cost-effectiveness ratios (dollars per years of life saved [YLS]).Results. No genotype had a projected life expectancy of 106.1 months, which with genotype increased to 108.3 months. Per-person discounted lifetime costs were $16 360 and $16 540, respectively. Compared to no genotype, genotype was very cost-effective, by international guidance, at $900/YLS. The cost-effectiveness of genotype was sensitive to prevalence of WT virus (very cost-effective when prevalence ≥12%), CD4 at first-line ART failure, and ART efficacy. Genotype-associated delays in care ≥5 months decreased survival and made no genotype the preferred strategy. When the test cost was <$100, genotype became cost-saving. Conclusions. Genotype resistance testing at first-line ART failure is very cost-effective in South Africa. The cost-effectiveness of this strategy will depend on prevalence of WT virus and timely response to genotype results. © 2012 The Author 2012. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup. com.

Author Keywords

antiretroviral treatment failure; HIV; resistance testing; resource-limited settings

Index Keywords

antiretrovirus agent; darunavir; etravirine; lopinavir plus ritonavir; nonnucleoside reverse transcriptase inhibitor; proteinase inhibitor; tenofovir; antiviral therapy; article; CD4 lymphocyte count; cost effectiveness analysis; drug efficacy; drug safety; drug treatment failure; genotype; gross national product; health care cost; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; life expectancy; major clinical study; priority journal; South Africa; survival; wild type; Acquired Immunodeficiency Syndrome; Adult; Anti-HIV Agents; Clinical Laboratory Techniques; Cost-Benefit Analysis; Genotype; Health Resources; HIV; HIV Infections; Humans; Models, Theoretical; South Africa; Treatment Failure

Funding Details

None