Economic evaluation of initial HAART regimen for HIV patients

Shafie, Asrul Akmal 2007. Economic evaluation of initial HAART regimen for HIV patients. PhD Thesis, Cardiff University.

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Abstract

Although highly active antiretroviral regimen' (HAART) reduces HIV-related morbidity and mortality, it affects patients and induces HIV viral resistance which could lead to more complex therapeutic regimens. The present study evaluated and compared the cost-effectiveness of a protease inhibitor based highly active antiretroviral regimen' (PHAART) with a non nucleoside reverse transcriptase inhibitor based highly active antiretroviral regimen' (NHAART) in HIV-patients. The impact of initial HAART was investigated using retrospective cost analysis over a 10-year period and 6 months prospective HRQoL analysis of 150 patients (male 125, mean age 40 years) attending the Cardiff Royal Infirmary and the University Hospital of Wales. Data was collected on each patient's care resource utilization and their health-related quality of life (HRQoL) assessed using the Health Utility Index Mark III (HUI3) questionnaire. The effect of the HAART regimen, demographic attributes and clinical characteristics on costs and HRQoL were analyzed using a multilevel model of change. A Markov Monte Carlo model was then developed to simulate the impact, and evaluate the cost effectiveness, of both regimens beyond the study time horizon. The mean monthly outpatient cost for all patients was estimated to be 237.59. Patients receiving NHAART as the initial regimen cost significantly more (p 0.01, mean 262.19) than patients receiving PHAART (mean 234.98). Other factors associated with higher costs were being a non-British national, having a low CD4 count, a high viral load, and having AIDS. Patients receiving an initial NHAART regimen had a significantly better HRQoL (p 0.05). Factors associated with a higher HRQoL included being in employment and being in the asymptomatic stage of HIV. With respect to lifetime cost-effectiveness analysis, PHAART was found to be more cost-effective as an initial regimen since the incremental cost-effectiveness ratio of 8,871 per quality adjusted life years (QALY) gained, was below the UK threshold of 30,000 per QALY. The findings of this study indicate that patients receiving NHAART as their initial regimen had higher outpatient costs than those initiated on PHAART, but had a better HRQoL. In the long term, however, PHAART was estimated to be more cost- effective than NHAART as an initial regimen for HIV patients.

Item Type:	Thesis (PhD)
Status:	Unpublished
Schools:	Medicine
Subjects:	Q Science > QR Microbiology > QR180 Immunology R Medicine > RM Therapeutics. Pharmacology
ISBN:	9781303181993
Date of First Compliant Deposit:	30 March 2016
Last Modified:	12 Feb 2016 23:14
URI:	https://orca.cardiff.ac.uk/id/eprint/55673

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