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1.
HIV Clin Trials ; 10(4): 233-53, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19723611

RESUMO

OBJECTIVES: Raltegravir, a novel integrase inhibitor, has shown great efficacy in reducing HIV viral load among treatment-experienced patients. A cohort state-transition model was used to assess the long-term effect of raltegravir treatment on costs and quality-adjusted life expectancy from a Swiss perspective. METHODS: Patients were stratified into health states according to opportunistic infection status, HIV RNA level, and CD4 count, with each group assigned a treatment cost and utility (quality of life) score. Model inputs came from published studies, clinical trials, and database analyses. Results were used to calculate incremental cost-effectiveness ratio (ICER) of raltegravir use, expressed in Swiss francs (CHF) as incremental cost/quality-adjusted life-year (QALY) gained. Future costs and QALYs were discounted at 3% per year. RESULTS: Five years of raltegravir treatment increased discounted quality-adjusted life expectancy by 3.73 years over placebo, with additional discounted cost of CHF 170,347, resulting in an ICER of CHF 45,687/QALY. ICERs ranged from CHF 42,751 to 53,478/QALY for treatment duration of 3 and 10 years, respectively. Results were most sensitive to changes in raltegravir treatment duration, source of estimated quality of life weights, and raltegravir price. CONCLUSIONS: Adding raltegravir to optimized background therapy was a cost-effective strategy for treatment-experienced patients in Switzerland.


Assuntos
Infecções por HIV/tratamento farmacológico , Inibidores de Integrase de HIV/uso terapêutico , HIV-1/crescimento & desenvolvimento , Modelos Econômicos , Pirrolidinonas/uso terapêutico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Infecções Oportunistas Relacionadas com a AIDS/virologia , Contagem de Linfócito CD4 , Estudos de Coortes , Simulação por Computador , Análise Custo-Benefício , Feminino , Infecções por HIV/economia , Infecções por HIV/microbiologia , Infecções por HIV/virologia , Inibidores de Integrase de HIV/economia , HIV-1/genética , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Pirrolidinonas/economia , Anos de Vida Ajustados por Qualidade de Vida , RNA Viral/sangue , Raltegravir Potássico , Suíça
2.
J Med Virol ; 65(2): 225-32, 2001 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11536227

RESUMO

Monitoring of viral RNA has become indispensable for the management of HIV-1 infection, but is expensive. This study investigated whether a highly improved test for p24 antigen could serve as an alternative. Thirty-four patients enrolled during 1997 into two treatment studies were tested prospectively for viral RNA by the Roche HIV-1 Monitor and for p24 antigen using signal-amplification-boosted ELISA of heat-denatured plasma. P24 antigen was detectable in 75.8% of 178 samples and HIV RNA in 73.9% of 138 samples. The half-life of p24 antigen in the first phase of effective treatment was 1.6 +/-.4 days (RNA, 1.7 +/-.8). An apparent second, slower decay phase had a half-life of 42 +/- 16 days. Treatment failure occurred in 14 patients. Secondary treatment failures with RNA rebounds from undetectable levels to < or = 10(3) copies/ml in two patients with an undetectable viral load and 10(3) HIV RNA copies/ml, respectively, at baseline were not detected by p24 antigen but carried a low risk for secondary resistance mutations. The other 12 failures were on average detected 29 days earlier by p24 antigen than by RNA (P =.0204), owing to slightly more frequent testing for p24 than for RNA (2.7 vs. 2.4 tests). Average costs for p24 antigen testing up to a failure were only 20.5% of those for RNA (P <.0001). These results indicate that heat-denatured, amplification-boosted p24 antigen measurement can be used as a simple and inexpensive alternative to HIV RNA testing for monitoring treatment.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Ensaio de Imunoadsorção Enzimática/métodos , Proteína do Núcleo p24 do HIV/sangue , Infecções por HIV/tratamento farmacológico , HIV-1/isolamento & purificação , RNA Viral/sangue , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Quimioterapia Combinada , Ensaio de Imunoadsorção Enzimática/economia , Infecções por HIV/sangue , Infecções por HIV/virologia , Meia-Vida , Humanos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Kit de Reagentes para Diagnóstico/economia , Resultado do Tratamento , Carga Viral
3.
J Antimicrob Chemother ; 44(6): 811-7, 1999 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-10590283

RESUMO

We conducted a cost-effectiveness analysis to determine the clinical and economic consequences of Mycobacterium avium complex (MAC) prophylaxis in HIV-infected patients in the era of highly active antiretroviral therapy (HAART) in a health care system with access unrestricted by financial barriers. The analysis was performed from a health care perspective and compared azithromycin (1200 mg/week) with no prophylaxis over a period of 10 years based on data from the Swiss HIV Cohort Study (SHCS) and randomized controlled trials. The main outcome measures were: expected survival; average health care costs; and cost-effectiveness in 1997 Swiss francs ( pound1 corresponds to about 2.3 CHF) per life-year saved. In patients with an initial CD4 count <50 cells/mm(3) and no AIDS, azithromycin increased expected survival by 4 months. In patients with AIDS, HAART durability had a major impact on expected survival and costs. Incremental survival increased from 2 to 4 months if we assumed a 10 year, instead of a 3 year, HAART effect. The cost-effectiveness of azithromycin relative to no prophylaxis in patients without AIDS was between 47,000 CHF (3-year HAART effect) and 60,000 CHF (10-year HAART effect) per life-year saved. The cost-effectiveness ratio increased to 118,000 CHF per life-year saved in patients with symptomatic AIDS. In conclusion, in the era of HAART, MAC prophylaxis with azithromycin increases expected survival and reduces health care costs substantially. Starting MAC prophylaxis in patients without AIDS is more effective and cost-effective than in patients with AIDS.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/economia , Azitromicina/uso terapêutico , Infecção por Mycobacterium avium-intracellulare/prevenção & controle , Antibacterianos/economia , Fármacos Anti-HIV/uso terapêutico , Azitromicina/economia , Teorema de Bayes , Estudos de Coortes , Análise Custo-Benefício , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Custos de Cuidados de Saúde , Humanos
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