Cost Effectiveness Analysis of Clinically Driven versus Routine Laboratory Monitoring of Antiretroviral Therapy in Uganda and Zimbabwe

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dc.contributor.authorLara, Antonieta Medina
dc.contributor.authorKigozi, Jesse
dc.contributor.authorAmurwon, Jovita
dc.contributor.authorMuchabaiwa, Lazarus
dc.contributor.authorWakaholi, Barbara Nyanzi
dc.contributor.authorMota, Ruben E. Mujica
dc.contributor.authorWalker, A. Sarah
dc.contributor.authorKasirye, Ronnie
dc.contributor.authorSsali, Francis
dc.contributor.authorReid, Andrew
dc.contributor.authorGrosskurth, Heiner
dc.contributor.authorBabiker, Abdel G.
dc.contributor.authorKityo, Cissy
dc.contributor.authorKatabira, Elly
dc.contributor.authorMunderi, Paula
dc.contributor.authorMugyenyi, Peter
dc.contributor.authorHakim, James
dc.contributor.authorDarbyshire, Janet
dc.contributor.authorGibb, Diana M.
dc.contributor.authorGilks, Charles F.
dc.date.accessioned2022-03-21T07:52:45Z
dc.date.available2022-03-21T07:52:45Z
dc.date.issued2012
dc.description.abstractDespite funding constraints for treatment programmes in Africa, the costs and economic consequences of routine laboratory monitoring for efficacy and toxicity of antiretroviral therapy (ART) have rarely been evaluated.Cost-effectiveness analysis was conducted in the DART trial (ISRCTN13968779). Adults in Uganda/Zimbabwe starting ART were randomised to clinically-driven monitoring (CDM) or laboratory and clinical monitoring (LCM); individual patient data on healthcare resource utilisation and outcomes were valued with primary economic costs and utilities. Total costs of first/second-line ART, routine 12-weekly CD4 and biochemistry/haematology tests, additional diagnostic investigations, clinic visits, concomitant medications and hospitalisations were considered from the public healthcare sector perspective. A Markov model was used to extrapolate costs and benefits 20 years beyond the trial.3316 (1660LCM;1656CDM) symptomatic, immunosuppressed ART-naive adults (median (IQR) age 37 (32,42); CD4 86 (31,139) cells/mm3) were followed for median 4.9 years. LCM had a mean 0.112 year (41 days) survival benefit at an additional mean cost of $765 [95%CI:685,845], translating into an adjusted incremental cost of $7386 [3277,dominated] per life-year gained and $7793 [4442,39179] per quality-adjusted life year gained. Routine toxicity tests were prominent cost-drivers and had no benefit. With 12-weekly CD4 monitoring from year 2 on ART, low-cost second-line ART, but without toxicity monitoring, CD4 test costs need to fall below $3.78 to become cost-effective (<3xper-capita GDP, following WHO benchmarks). CD4 monitoring at current costs as undertaken in DART was not cost-effective in the long-term.There is no rationale for routine toxicity monitoring, which did not affect outcomes and was costly. Even though beneficial, there is little justification for routine 12-weekly CD4 monitoring of ART at current test costs in low-income African countries. CD4 monitoring, restricted to the second year on ART onwards, could be cost-effective with lower cost second-line therapy and development of a cheaper, ideally point-of-care, CD4 test.en_US
dc.identifier.citationMedina Lara, A., Kigozi, J., Amurwon, J., Muchabaiwa, L., Nyanzi Wakaholi, B., Mujica Mota, R. E., ... & DART Trial Team. (2012). Cost effectiveness analysis of clinically driven versus routine laboratory monitoring of antiretroviral therapy in Uganda and Zimbabwe. PloS one, 7(4), e33672.https://doi.org/10.1371/journal.pone.0033672en_US
dc.identifier.urihttps://nru.uncst.go.ug/xmlui/handle/123456789/2850
dc.language.isoenen_US
dc.publisherPloS oneen_US
dc.titleCost Effectiveness Analysis of Clinically Driven versus Routine Laboratory Monitoring of Antiretroviral Therapy in Uganda and Zimbabween_US
dc.typeArticleen_US
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