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Home >> Publications >> Cost-effectiveness of point-of-care viral load monitoring of antiretroviral therapy in resource-limited settings: mathematical modelling study.

Publication

Author(s):

Estill J, Egger M, Blaser N, Vizcaya LS, Garone D, Wood R, Campbell J, Hallett TB, Keiser O; IeDEA Southern Africa.

Pub Title:

Cost-effectiveness of point-of-care viral load monitoring of antiretroviral therapy in resource-limited settings: mathematical modelling study.

Pub Date:

Jun 1 2013

Pub Region(s):

Southern Africa

Journal Issue:

27(9)

Page Number:
1483-1492

Journal:

Title: 
AIDS
Link: 
http://bit.ly/HRY4VU

PubMed: 23462219
Pub PDF: PDF icon 23462219.pdf

Abstract
BACKGROUND
: Monitoring of HIV viral load in patients on combination antiretroviral therapy (ART) is not generally available in resource-limited settings. We examined the cost-effectiveness of qualitative point-of-care viral load tests (POC-VL) in sub-Saharan Africa.

DESIGN: Mathematical model based on longitudinal data from the Gugulethu and Khayelitsha township ART programmes in Cape Town, South Africa.

METHODS: Cohorts of patients on ART monitored by POC-VL, CD4 cell count or clinically were simulated. Scenario A considered the more accurate detection of treatment failure with POC-VL only, and scenario B also considered the effect on HIV transmission. Scenario C further assumed that the risk of virologic failure is halved with POC-VL due to improved adherence. We estimated the change in costs per quality-adjusted life-year gained (incremental cost-effectiveness ratios, ICERs) of POC-VL compared with CD4 and clinical monitoring.

RESULTS: POC-VL tests with detection limits less than 1000 copies/ml increased costs due to unnecessary switches to second-line ART, without improving survival. Assuming POC-VL unit costs between US$5 and US$20 and detection limits between 1000 and 10,000 copies/ml, the ICER of POC-VL was US$4010-US$9230 compared with clinical and US$5960-US$25540 compared with CD4 cell count monitoring. In Scenario B, the corresponding ICERs were US$2450-US$5830 and US$2230-US$10380. In Scenario C, the ICER ranged between US$960 and US$2500 compared with clinical monitoring and between cost-saving and US$2460 compared with CD4 monitoring.

CONCLUSION: The cost-effectiveness of POC-VL for monitoring ART is improved by a higher detection limit, by taking the reduction in new HIV infections into account and assuming that failure of first-line ART is reduced due to targeted adherence counselling.

 

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Citation:

Estill J, Egger M, Blaser N, Vizcaya LS, Garone D, Wood R, Campbell J, Hallett TB, Keiser O; IeDEA Southern Africa. Cost-effectiveness of point-of-care viral load monitoring of antiretroviral therapy in resource-limited settings: mathematical modelling study. AIDS. 2013 Jun 1;27(9):1483-92. doi: 10.1097/QAD.0b013e328360a4e5. PubMed PMID: 23462219; PubMed Central PMCID: PMC3813830.