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HIV cure strategies: how good must they be to improve on current antiretroviral therapy?

Sax PE, Sypek A, Berkowitz BK, Morris BL, Losina E, Paltiel AD, Kelly KA, Seage GR, Walensky RP, Weinstein MC, Eron J, Freedberg KA - PLoS ONE (2014)

Bottom Line: Outcomes included quality-adjusted life expectancy, lifetime cost, and cost-effectiveness in dollars/quality-adjusted life year ($/QALY) gained.Strategies were deemed cost-effective with incremental cost-effectiveness ratios <$100,000/QALY.These results may help provide performance targets for developing cure strategies for HIV.

View Article: PubMed Central - PubMed

Affiliation: Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts, United States of America.

ABSTRACT

Background: We examined efficacy, toxicity, relapse, cost, and quality-of-life thresholds of hypothetical HIV cure interventions that would make them cost-effective compared to life-long antiretroviral therapy (ART).

Methods: We used a computer simulation model to assess three HIV cure strategies: Gene Therapy, Chemotherapy, and Stem Cell Transplantation (SCT), each compared to ART. Efficacy and cost parameters were varied widely in sensitivity analysis. Outcomes included quality-adjusted life expectancy, lifetime cost, and cost-effectiveness in dollars/quality-adjusted life year ($/QALY) gained. Strategies were deemed cost-effective with incremental cost-effectiveness ratios <$100,000/QALY.

Results: For patients on ART, discounted quality-adjusted life expectancy was 16.4 years and lifetime costs were $591,400. Gene Therapy was cost-effective with efficacy of 10%, relapse rate 0.5%/month, and cost $54,000. Chemotherapy was cost-effective with efficacy of 88%, relapse rate 0.5%/month, and cost $12,400/month for 24 months. At $150,000/procedure, SCT was cost-effective with efficacy of 79% and relapse rate 0.5%/month. Moderate efficacy increases and cost reductions made Gene Therapy cost-saving, but substantial efficacy/cost changes were needed to make Chemotherapy or SCT cost-saving.

Conclusions: Depending on efficacy, relapse rate, and cost, cure strategies could be cost-effective compared to current ART and potentially cost-saving. These results may help provide performance targets for developing cure strategies for HIV.

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Related in: MedlinePlus

Stem Cell Transplantation compared to standard of care ART.The figure depicts the cost-effectiveness of Stem Cell Transplantation compared to standard of care ART as a function of the three influential parameters identified via the one-way sensitivity analysis in Table 3: cost, relapse rate, and efficacy. In each panel, the horizontal axis denotes efficacy while the vertical axis denotes the relapse rate. Inside each panel, the shading denotes the resultant cost-effectiveness finding, ranging from cost-saving (green), through cost-effective (with an ICER<$100,000/QALY, yellow), to not cost-effective (≥$100,000/QALY or more expensive and less effective than ART, red). Instances where the intervention is both less expensive and less effective than ART are denoted in blue, but most were not cost-effective because the ICER of ART was <$100,000/QALY compared to SCT. The plus sign indicates a strategy that had an ICER for ART compared to SCT >$100,000/QALY gained. ART: antiretroviral therapy; ICER: incremental cost-effectiveness ration; QALY: quality-adjusted life year.
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pone-0113031-g003: Stem Cell Transplantation compared to standard of care ART.The figure depicts the cost-effectiveness of Stem Cell Transplantation compared to standard of care ART as a function of the three influential parameters identified via the one-way sensitivity analysis in Table 3: cost, relapse rate, and efficacy. In each panel, the horizontal axis denotes efficacy while the vertical axis denotes the relapse rate. Inside each panel, the shading denotes the resultant cost-effectiveness finding, ranging from cost-saving (green), through cost-effective (with an ICER<$100,000/QALY, yellow), to not cost-effective (≥$100,000/QALY or more expensive and less effective than ART, red). Instances where the intervention is both less expensive and less effective than ART are denoted in blue, but most were not cost-effective because the ICER of ART was <$100,000/QALY compared to SCT. The plus sign indicates a strategy that had an ICER for ART compared to SCT >$100,000/QALY gained. ART: antiretroviral therapy; ICER: incremental cost-effectiveness ration; QALY: quality-adjusted life year.

Mentions: In most sensitivity analyses, SCT was not cost-effective. In selected cases where the cost was extremely low or efficacy very high, SCT became cost-saving (Figure 3). For one parameter combination, SCT was less effective and less expensive than ART, but it was not cost-effective because the ICER of ART was <$100,000/QALY compared to SCT. If the cost of SCT was halved ($75,000), the combinations where the intervention was cost-saving remained roughly the same, but several scenarios that were not cost-effective in the base case became less expensive and less effective than ART.


HIV cure strategies: how good must they be to improve on current antiretroviral therapy?

Sax PE, Sypek A, Berkowitz BK, Morris BL, Losina E, Paltiel AD, Kelly KA, Seage GR, Walensky RP, Weinstein MC, Eron J, Freedberg KA - PLoS ONE (2014)

Stem Cell Transplantation compared to standard of care ART.The figure depicts the cost-effectiveness of Stem Cell Transplantation compared to standard of care ART as a function of the three influential parameters identified via the one-way sensitivity analysis in Table 3: cost, relapse rate, and efficacy. In each panel, the horizontal axis denotes efficacy while the vertical axis denotes the relapse rate. Inside each panel, the shading denotes the resultant cost-effectiveness finding, ranging from cost-saving (green), through cost-effective (with an ICER<$100,000/QALY, yellow), to not cost-effective (≥$100,000/QALY or more expensive and less effective than ART, red). Instances where the intervention is both less expensive and less effective than ART are denoted in blue, but most were not cost-effective because the ICER of ART was <$100,000/QALY compared to SCT. The plus sign indicates a strategy that had an ICER for ART compared to SCT >$100,000/QALY gained. ART: antiretroviral therapy; ICER: incremental cost-effectiveness ration; QALY: quality-adjusted life year.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4232561&req=5

pone-0113031-g003: Stem Cell Transplantation compared to standard of care ART.The figure depicts the cost-effectiveness of Stem Cell Transplantation compared to standard of care ART as a function of the three influential parameters identified via the one-way sensitivity analysis in Table 3: cost, relapse rate, and efficacy. In each panel, the horizontal axis denotes efficacy while the vertical axis denotes the relapse rate. Inside each panel, the shading denotes the resultant cost-effectiveness finding, ranging from cost-saving (green), through cost-effective (with an ICER<$100,000/QALY, yellow), to not cost-effective (≥$100,000/QALY or more expensive and less effective than ART, red). Instances where the intervention is both less expensive and less effective than ART are denoted in blue, but most were not cost-effective because the ICER of ART was <$100,000/QALY compared to SCT. The plus sign indicates a strategy that had an ICER for ART compared to SCT >$100,000/QALY gained. ART: antiretroviral therapy; ICER: incremental cost-effectiveness ration; QALY: quality-adjusted life year.
Mentions: In most sensitivity analyses, SCT was not cost-effective. In selected cases where the cost was extremely low or efficacy very high, SCT became cost-saving (Figure 3). For one parameter combination, SCT was less effective and less expensive than ART, but it was not cost-effective because the ICER of ART was <$100,000/QALY compared to SCT. If the cost of SCT was halved ($75,000), the combinations where the intervention was cost-saving remained roughly the same, but several scenarios that were not cost-effective in the base case became less expensive and less effective than ART.

Bottom Line: Outcomes included quality-adjusted life expectancy, lifetime cost, and cost-effectiveness in dollars/quality-adjusted life year ($/QALY) gained.Strategies were deemed cost-effective with incremental cost-effectiveness ratios <$100,000/QALY.These results may help provide performance targets for developing cure strategies for HIV.

View Article: PubMed Central - PubMed

Affiliation: Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, United States of America; Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts, United States of America.

ABSTRACT

Background: We examined efficacy, toxicity, relapse, cost, and quality-of-life thresholds of hypothetical HIV cure interventions that would make them cost-effective compared to life-long antiretroviral therapy (ART).

Methods: We used a computer simulation model to assess three HIV cure strategies: Gene Therapy, Chemotherapy, and Stem Cell Transplantation (SCT), each compared to ART. Efficacy and cost parameters were varied widely in sensitivity analysis. Outcomes included quality-adjusted life expectancy, lifetime cost, and cost-effectiveness in dollars/quality-adjusted life year ($/QALY) gained. Strategies were deemed cost-effective with incremental cost-effectiveness ratios <$100,000/QALY.

Results: For patients on ART, discounted quality-adjusted life expectancy was 16.4 years and lifetime costs were $591,400. Gene Therapy was cost-effective with efficacy of 10%, relapse rate 0.5%/month, and cost $54,000. Chemotherapy was cost-effective with efficacy of 88%, relapse rate 0.5%/month, and cost $12,400/month for 24 months. At $150,000/procedure, SCT was cost-effective with efficacy of 79% and relapse rate 0.5%/month. Moderate efficacy increases and cost reductions made Gene Therapy cost-saving, but substantial efficacy/cost changes were needed to make Chemotherapy or SCT cost-saving.

Conclusions: Depending on efficacy, relapse rate, and cost, cure strategies could be cost-effective compared to current ART and potentially cost-saving. These results may help provide performance targets for developing cure strategies for HIV.

Show MeSH
Related in: MedlinePlus