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Phillips AN, Cambiano V, Miners A, et al. Effectiveness and cost-effectiveness of potential responses to future high levels of transmitted HIV drug resistance in antiretroviral drug-naive populations beginning treatment: modelling study and economic analysis. Lancet HIV. 2014;1(2):e85-93doi: 10.1016/S2352-3018(14)70021-9.
Phillips, A. N., Cambiano, V., Miners, A., Revill, P., Pillay, D., Lundgren, J. D., Bennett, D., Raizes, E., Nakagawa, F., De Luca, A., Vitoria, M., Barcarolo, J., Perriens, J., Jordan, M. R., & Bertagnolio, S. (2014). Effectiveness and cost-effectiveness of potential responses to future high levels of transmitted HIV drug resistance in antiretroviral drug-naive populations beginning treatment: modelling study and economic analysis. The lancet. HIV, 1(2), e85-93. https://doi.org/10.1016/S2352-3018(14)70021-9
Phillips, Andrew N, et al. "Effectiveness and cost-effectiveness of potential responses to future high levels of transmitted HIV drug resistance in antiretroviral drug-naive populations beginning treatment: modelling study and economic analysis." The lancet. HIV vol. 1,2 (2014): e85-93. doi: https://doi.org/10.1016/S2352-3018(14)70021-9
Phillips AN, Cambiano V, Miners A, Revill P, Pillay D, Lundgren JD, Bennett D, Raizes E, Nakagawa F, De Luca A, Vitoria M, Barcarolo J, Perriens J, Jordan MR, Bertagnolio S. Effectiveness and cost-effectiveness of potential responses to future high levels of transmitted HIV drug resistance in antiretroviral drug-naive populations beginning treatment: modelling study and economic analysis. Lancet HIV. 2014 Nov;1(2):e85-93. doi: 10.1016/S2352-3018(14)70021-9. Epub 2014 Oct 14. PMID: 26423990; PMCID: PMC4822192.
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Lancet HIV. 2014 Nov;1(2):e85-93. doi: 10.1016/S2352-3018(14)70021-9. Epub 2014 Oct 14.

Effectiveness and cost-effectiveness of potential responses to future high levels of transmitted HIV drug resistance in antiretroviral drug-naive populations beginning treatment: modelling study and economic analysis.

The lancet. HIV

Andrew N Phillips, Valentina Cambiano, Alec Miners, Paul Revill, Deenan Pillay, Jens D Lundgren, Diane Bennett, Elliott Raizes, Fumiyo Nakagawa, Andrea De Luca, Marco Vitoria, Jhoney Barcarolo, Joseph Perriens, Michael R Jordan, Silvia Bertagnolio

Affiliations

  1. Research Department of Infection and Population Health, University College London, London, UK. Electronic address: [email protected].
  2. Research Department of Infection and Population Health, University College London, London, UK.
  3. London School of Hygiene & Tropical Medicine, London, UK.
  4. University of York, York, UK.
  5. Africa Centre, KwaZulu Natal, South Africa.
  6. Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
  7. Centers for Disease Control and Prevention, Atlanta, GA, USA.
  8. University Division of Infectious Diseases, Siena University Hospital, Siena, Italy.
  9. World Health Organization, Geneva, Switzerland.
  10. Tufts University School of Medicine and Tufts Medical Center, Boston, MA, USA.
  11. World Health Organization, Geneva, Switzerland. Electronic address: [email protected].

PMID: 26423990 PMCID: PMC4822192 DOI: 10.1016/S2352-3018(14)70021-9

Abstract

BACKGROUND: With continued roll-out of antiretroviral therapy (ART) in resource-limited settings, evidence is emerging of increasing levels of transmitted drug-resistant HIV. We aimed to compare the effectiveness and cost-effectiveness of different potential public health responses to substantial levels of transmitted drug resistance.

METHODS: We created a model of HIV transmission, progression, and the effects of ART, which accounted for resistance generation, transmission, and disappearance of resistance from majority virus in the absence of drug pressure. We simulated 5000 ART programmatic scenarios with different prevalence levels of detectable resistance in people starting ART in 2017 (t0) who had not previously been exposed to antiretroviral drugs. We used the model to predict cost-effectiveness of various potential changes in policy triggered by different prevalence levels of resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) measured in the population starting ART.

FINDINGS: Individual-level resistance testing before ART initiation was not generally a cost-effective option, irrespective of the cost-effectiveness threshold. At a cost-effectiveness threshold of US$500 per quality-adjusted life-year (QALY), no change in policy was cost effective (ie, no change in policy would involve paying less than $500 per QALY gained), irrespective of the prevalence of pretreatment NNRTI resistance, because of the increased cost of the policy alternatives. At thresholds of $1000 or higher, and with the prevalence of pretreatment NNRTI resistance greater than 10%, a policy to measure viral load 6 months after ART initiation became cost effective. The policy option to change the standard first-line treatment to a boosted protease inhibitor regimen became cost effective at a prevalence of NNRTI resistance higher than 15%, for cost-effectiveness thresholds greater than $2000.

INTERPRETATION: Cost-effectiveness of potential policies to adopt in response to different levels of pretreatment HIV drug resistance depends on competing budgetary claims, reflected in the cost-effectiveness threshold. Results from our model will help inform WHO recommendations on monitoring of HIV drug resistance in people starting ART.

FUNDING: WHO (with funds provided by the Bill & Melinda Gates Foundation), CHAIN (European Commission).

Copyright © 2014 World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved. Published by Elsevier Ltd.. All rights reserved.

References

  1. Curr Drug Targets Infect Disord. 2003 Dec;3(4):345-53 - PubMed
  2. AIDS Res Treat. 2011;2011:769627 - PubMed
  3. Clin Infect Dis. 2008 Sep 1;47(5):712-22 - PubMed
  4. Clin Infect Dis. 2012 May;54 Suppl 4:S245-9 - PubMed
  5. Lancet. 2012 Oct 6;380(9849):1250-8 - PubMed
  6. Curr Opin HIV AIDS. 2013 Nov;8(6):544-9 - PubMed
  7. J Infect Dis. 2013 Mar 1;207(5):759-67 - PubMed
  8. J Infect Dis. 2013 Jun 15;207 Suppl 2:S78-84 - PubMed
  9. AIDS Rev. 2012 Jan-Mar;14(1):17-27 - PubMed
  10. Nat Med. 2001 Jun;7(6):712-8 - PubMed
  11. PLoS Med. 2006 Apr;3(4):e124 - PubMed
  12. PLoS Med. 2012;9(6):e1001236 - PubMed
  13. PLoS One. 2007 Jan 17;2(1):e152 - PubMed
  14. Health Res Policy Syst. 2011 Jan 17;9:4 - PubMed
  15. BMJ. 2012 Mar 02;344:d7883 - PubMed
  16. AIDS. 2005 Jan 3;19(1):1-14 - PubMed
  17. J Acquir Immune Defic Syndr. 2013 Sep 1;64(1):74-8 - PubMed
  18. J Infect Dis. 2013 Jun 15;207 Suppl 2:S57-62 - PubMed
  19. AIDS. 2011 Mar 27;25(6):843-50 - PubMed
  20. Clin Infect Dis. 2009 Dec 15;49(12):1928-35 - PubMed
  21. Lancet Infect Dis. 2012 Apr;12(4):307-17 - PubMed
  22. Int J Technol Assess Health Care. 1991;7(1):12-21 - PubMed
  23. Antivir Ther. 2008;13 Suppl 2:25-36 - PubMed
  24. J Infect Dis. 2014 Mar 1;209(5):711-20 - PubMed
  25. Lancet Glob Health. 2014 Jan;2(1):e35-43 - PubMed
  26. Lancet. 2004 Jul 3-9;364(9428):51-62 - PubMed
  27. Med Decis Making. 1998 Apr-Jun;18(2 Suppl):S68-80 - PubMed
  28. PLoS One. 2010 Jun 08;5(6):e10981 - PubMed
  29. AIDS. 2014 Jan;28 Suppl 1:S15-23 - PubMed
  30. Antivir Ther. 2010;15(4):563-70 - PubMed
  31. AIDS. 2007 May 11;21(8):973-82 - PubMed

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