Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa.
<h4>Background</h4>Interventions based around objective measurement of adherence to antiretroviral drugs for HIV have potential to improve adherence and to enable differentiation of care such that clinical visits are reduced in those with high adherence. It would be useful to understand...
Saved in:
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2016-01-01
|
| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0167654&type=printable |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850232494550417408 |
|---|---|
| author | Andrew N Phillips Valentina Cambiano Fumiyo Nakagawa Loveleen Bansi-Matharu Papa Salif Sow Peter Ehrenkranz Deborah Ford Owen Mugurungi Tsitsi Apollo Joseph Murungu David R Bangsberg Paul Revill |
| author_facet | Andrew N Phillips Valentina Cambiano Fumiyo Nakagawa Loveleen Bansi-Matharu Papa Salif Sow Peter Ehrenkranz Deborah Ford Owen Mugurungi Tsitsi Apollo Joseph Murungu David R Bangsberg Paul Revill |
| author_sort | Andrew N Phillips |
| collection | DOAJ |
| description | <h4>Background</h4>Interventions based around objective measurement of adherence to antiretroviral drugs for HIV have potential to improve adherence and to enable differentiation of care such that clinical visits are reduced in those with high adherence. It would be useful to understand the approximate upper limit of cost that could be considered for such interventions of a given effectiveness in order to be cost effective. Such information can guide whether to implement an intervention in the light of a trial showing a certain effectiveness and cost.<h4>Methods</h4>An individual-based model, calibrated to Zimbabwe, which incorporates effects of adherence and resistance to antiretroviral therapy, was used to model the potential impact of adherence monitoring-based interventions on viral suppression, death rates, disability adjusted life years and costs. Potential component effects of the intervention were: enhanced average adherence when on ART, reduced risk of ART discontinuation, and reduced risk of resistance acquisition. We considered a situation in which viral load monitoring is not available and one in which it is. In the former case, it was assumed that care would be differentiated based on the adherence level, with fewer clinic visits in those demonstrated to have high adherence. In the latter case, care was assumed to be primarily differentiated according to viral load level. The maximum intervention cost required to be cost effective was calculated based on a cost effectiveness threshold of $500 per DALY averted.<h4>Findings</h4>In the absence of viral load monitoring, an adherence monitoring-based intervention which results in a durable 6% increase in the proportion of ART experienced people with viral load < 1000 cps/mL was cost effective if it cost up to $50 per person-year on ART, mainly driven by the cost savings of differentiation of care. In the presence of viral load monitoring availability, an intervention with a similar effect on viral load suppression was cost-effective when costing $23-$32 per year, depending on whether the adherence intervention is used to reduce the level of need for viral load measurement.<h4>Conclusion</h4>The cost thresholds identified suggest that there is clear scope for adherence monitoring-based interventions to provide net population health gain, with potential cost-effective use in situations where viral load monitoring is or is not available. Our results guide the implementation of future adherence monitoring interventions found in randomized trials to have health benefit. |
| format | Article |
| id | doaj-art-a5edc24a210846b2a561d12d0516f445 |
| institution | OA Journals |
| issn | 1932-6203 |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj-art-a5edc24a210846b2a561d12d0516f4452025-08-20T02:03:12ZengPublic Library of Science (PLoS)PLoS ONE1932-62032016-01-011112e016765410.1371/journal.pone.0167654Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa.Andrew N PhillipsValentina CambianoFumiyo NakagawaLoveleen Bansi-MatharuPapa Salif SowPeter EhrenkranzDeborah FordOwen MugurungiTsitsi ApolloJoseph MurunguDavid R BangsbergPaul Revill<h4>Background</h4>Interventions based around objective measurement of adherence to antiretroviral drugs for HIV have potential to improve adherence and to enable differentiation of care such that clinical visits are reduced in those with high adherence. It would be useful to understand the approximate upper limit of cost that could be considered for such interventions of a given effectiveness in order to be cost effective. Such information can guide whether to implement an intervention in the light of a trial showing a certain effectiveness and cost.<h4>Methods</h4>An individual-based model, calibrated to Zimbabwe, which incorporates effects of adherence and resistance to antiretroviral therapy, was used to model the potential impact of adherence monitoring-based interventions on viral suppression, death rates, disability adjusted life years and costs. Potential component effects of the intervention were: enhanced average adherence when on ART, reduced risk of ART discontinuation, and reduced risk of resistance acquisition. We considered a situation in which viral load monitoring is not available and one in which it is. In the former case, it was assumed that care would be differentiated based on the adherence level, with fewer clinic visits in those demonstrated to have high adherence. In the latter case, care was assumed to be primarily differentiated according to viral load level. The maximum intervention cost required to be cost effective was calculated based on a cost effectiveness threshold of $500 per DALY averted.<h4>Findings</h4>In the absence of viral load monitoring, an adherence monitoring-based intervention which results in a durable 6% increase in the proportion of ART experienced people with viral load < 1000 cps/mL was cost effective if it cost up to $50 per person-year on ART, mainly driven by the cost savings of differentiation of care. In the presence of viral load monitoring availability, an intervention with a similar effect on viral load suppression was cost-effective when costing $23-$32 per year, depending on whether the adherence intervention is used to reduce the level of need for viral load measurement.<h4>Conclusion</h4>The cost thresholds identified suggest that there is clear scope for adherence monitoring-based interventions to provide net population health gain, with potential cost-effective use in situations where viral load monitoring is or is not available. Our results guide the implementation of future adherence monitoring interventions found in randomized trials to have health benefit.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0167654&type=printable |
| spellingShingle | Andrew N Phillips Valentina Cambiano Fumiyo Nakagawa Loveleen Bansi-Matharu Papa Salif Sow Peter Ehrenkranz Deborah Ford Owen Mugurungi Tsitsi Apollo Joseph Murungu David R Bangsberg Paul Revill Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa. PLoS ONE |
| title | Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa. |
| title_full | Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa. |
| title_fullStr | Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa. |
| title_full_unstemmed | Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa. |
| title_short | Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa. |
| title_sort | cost effectiveness of potential art adherence monitoring interventions in sub saharan africa |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0167654&type=printable |
| work_keys_str_mv | AT andrewnphillips costeffectivenessofpotentialartadherencemonitoringinterventionsinsubsaharanafrica AT valentinacambiano costeffectivenessofpotentialartadherencemonitoringinterventionsinsubsaharanafrica AT fumiyonakagawa costeffectivenessofpotentialartadherencemonitoringinterventionsinsubsaharanafrica AT loveleenbansimatharu costeffectivenessofpotentialartadherencemonitoringinterventionsinsubsaharanafrica AT papasalifsow costeffectivenessofpotentialartadherencemonitoringinterventionsinsubsaharanafrica AT peterehrenkranz costeffectivenessofpotentialartadherencemonitoringinterventionsinsubsaharanafrica AT deborahford costeffectivenessofpotentialartadherencemonitoringinterventionsinsubsaharanafrica AT owenmugurungi costeffectivenessofpotentialartadherencemonitoringinterventionsinsubsaharanafrica AT tsitsiapollo costeffectivenessofpotentialartadherencemonitoringinterventionsinsubsaharanafrica AT josephmurungu costeffectivenessofpotentialartadherencemonitoringinterventionsinsubsaharanafrica AT davidrbangsberg costeffectivenessofpotentialartadherencemonitoringinterventionsinsubsaharanafrica AT paulrevill costeffectivenessofpotentialartadherencemonitoringinterventionsinsubsaharanafrica |