Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-01T01:37:13.076Z Has data issue: false hasContentIssue false
  • English
  • Français

COST-EFFECTIVENESS OF ADHERENCE INTERVENTIONS FOR HIGHLY ACTIVE ANTIRETROVIRAL THERAPY: A SYSTEMATIC REVIEW

Published online by Cambridge University Press:  12 June 2013

Tim Mathes ,
Dawid Pieper ,
Sunya-Lee Antoine  and
Michaela Eikermann
Tim Mathes
Affiliation:
Institute for Research in Operative Medicine, Witten/Herdecke University
Dawid Pieper
Affiliation:
Institute for Research in Operative Medicine, Witten/Herdecke University
Sunya-Lee Antoine
Affiliation:
Institute for Research in Operative Medicine, Witten/Herdecke University
Michaela Eikermann
Affiliation:
Institute for Research in Operative Medicine, Witten/Herdecke University
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: The objective of this systematic review was to evaluate the cost-effectiveness of interventions aiming to increase the adherence to highly active antiretroviral therapy (HAART) in HIV-infected patients in developed countries (WHO stratum A).

Methods: A systematic search for comparative health economic studies was conducted in the following databases: EMBASE, MEDLINE, NHS Economic Evaluation Database, CINAHL, HEED, and EconLit. The identified publications were selected by two reviewers independently according to predefined inclusion and exclusion criteria. Furthermore, these were evaluated according to a standardized checklist and finally extracted, analyzed, and summarized.

Results: After reviewing the abstracts and full texts four relevant studies were identified. Different educational programs were compared as well as the Directly Observed Therapy (DOT). A critical aspect to be considered in particular was the poor transparency of the cost data. In three cost-utility analyses the costs per quality-adjusted life-year (QALY) in the baseline scenario were each under USD 15,000. The sensitivity analyses with a presumed maximum threshold of USD 50,000/QALY showed a predominantly cost-effective result. In one study that examined DOT the costs add up to over USD 150,000/QALY.

Conclusions: It seems that adherence interventions for HAART in HIV-infected patients can be cost-effective. Nevertheless, the quality of the included studies is deficient and only a few of the possible adherence interventions are taken into consideration. A final assessment of the cost-effectiveness of adherence interventions in general is, therefore, not possible.

Keywords

Medication AdherenceHIVCosts and Cost Analysissystematic review
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 29 , Issue 3 , July 2013 , pp. 227 - 233
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Gorenoi, V, Schoenermark, MP, Hagen, A. Interventions for enhancing medication compliance/adherence with benefits in treatment outcomes Cologne: German Agency for Health Technology Assessment at the German Institute for Medical Documentation and Information (DAHTA DIMDI) [Internet]. 2007. http://www.mrw.interscience.wiley.com/cochrane/clhta/articles/HTA-32008100213/frame.html (accessed May 7, 2012).Google Scholar
2.Sabaté, E. Adherence to long-term therapies-Evidence for action. Geneva: WHO; 2003. 07.05.2012.Google Scholar
3.Thompson, MA, Mugavero, MJ, Amico, KR, et al.Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: Evidence-based recommendations from an international association of physicians in AIDS Care Panel. Ann Intern Med. 2012;156:817–833.CrossRefGoogle ScholarPubMed
4.Scalera, A, Bayoumi, AM, Oh, P, Risebrough, N, Shear, N, Tseng, ALI. Clinical and economic implications of non-adherence to HAART in HIV infection. Dis Manag Health Outcome. 2002;10:85–91.CrossRefGoogle Scholar
5.Haynes, RB, Ackloo, E, Sahota, N, McDonald Heather, P, Yao, X. Interventions for enhancing medication adherence. Cochrane Database Syst Rev [Internet]. 2008. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000011.pub3/abstract;jsessionid=EF0298E221306889D43A2C94BBA08A50.d02t02.10.1002/14651858.CD000011.pub3 (accessed Month day, year).Google Scholar
6.Carballo, E, Cadarso-Suarez, C, Carrera, I, et al.Assessing relationships between health-related quality of life and adherence to antiretroviral therapy. Qual Life Res. 2004;13:587–599.CrossRefGoogle ScholarPubMed
7.Golay, A. Pharmacoeconomic aspects of poor adherence: Can better adherence reduce healthcare costs? J Med Econ. 2011;14:594–608.CrossRefGoogle ScholarPubMed
8.Ludwig Boltzmann Institut. (Internes) Manual Abläufe und Methoden. Teil 2. HTA-Projektberichte Nr. 2007;006.Google Scholar
9.Zechmeister, I, Wild, C. Einsatz von Statinen zur Sekundärprävention von Kardio-vaskulären Erkrankungen. Ein systematischer Review gesundheitsökonomischer Analysen. Wien: Österreichische Akademie der Wissenschaften, 2006.Google Scholar
10.Dreier, M, Borutta, B, Stahmeyer, J, Krauth, C, Walter, U. Vergleich von Bewertungsinstrumenten für die Studienqualität von Primär- und Sekundärstudien zur Verwendung für HTA-Berichte im deutschsprachigen Raum. Schriftenreihe Health Technology Assessment (HTA). 2010; Band 102.Google Scholar
11.World Health Organisation. Threshold values for intervention cost-effectiveness by Region 2013. http://www.who.int/choice/costs/CER_thresholds/en/index.html (accessed December 12, 2012).Google Scholar
12.Braithwaite, RS, Roberts, MS, Justice, AC. Incorporating quality of evidence into decision analytic modeling. Ann Intern Med. 2007;146:133–141.CrossRefGoogle ScholarPubMed
13.Freedberg, KA, Hirschhorn, LR, Schackman, BR, et al.Cost-effectiveness of an intervention to improve adherence to antiretroviral therapy in HIV-infected patients. JAIDS. 2006;43(Suppl 1):S113–118.Google ScholarPubMed
14.McCabe, CJ, Goldie, SJ, Fisman, DN. The cost-effectiveness of directly observed highly-active antiretroviral therapy in the third trimester in HIV-infected pregnant women. PLoS One. 2010;5:e10154.CrossRefGoogle ScholarPubMed
15.Zaric, GS, Bayoumi, AM, Brandeau, ML, Owens, DK. The cost-effectiveness of counseling strategies to improve adherence to highly active antiretroviral therapy among men who have sex with men. Med Decis Making. 2008;28:359–376.CrossRefGoogle ScholarPubMed
16.Goldie, SJ, Paltiel, AD, Weinstein, MC, et al.Projecting the cost-effectiveness of adherence interventions in persons with human immunodeficiency virus infection. Am J Med. 2003;115:632–641.CrossRefGoogle ScholarPubMed
17.Munakata, J, Benner, JS, Becker, S, Dezii, CM, Hazard, EH, Tierce, JC. Clinical and economic outcomes of nonadherence to highly active antiretroviral therapy in patients with human immunodeficiency virus. Med Care. 2006;44:893–899.CrossRefGoogle ScholarPubMed
18.Centers for Disease Control and Prevention (CDC). HIV incidence among young men who have sex with men–seven U.S. cities, 1994–2000. MMWR Morb Mortal Wkly Rep. 2001;50:4404.Google Scholar
19.Centers for Disease Control and Prevention (CDC). HIV prevalence, unrecognized infection, and HIV testing among men who have sex with men–five U.S. cities, June 2004-April 2005. MMWR Morb Mortal Wkly Rep. 2005;54:597–601.Google Scholar
20.Hart, JE, Jeon, CY, Ivers, LC, et al.Effect of directly observed therapy for highly active antiretroviral therapy on virologic, immunologic, and adherence outcomes: A meta-analysis and systematic review. JAIDS. 2010;54:167–179.Google ScholarPubMed
21.Ding, H, Wilson, CM, Modjarrad, K, McGwin, G Jr, Tang, J, Vermund, SH. Predictors of suboptimal virologic response to highly active antiretroviral therapy among human immunodeficiency virus-infected adolescents: Analyses of the reaching for excellence in adolescent care and health (REACH) project. Arch Pediatr Adolesc Med. 2009;163:1100–1105.CrossRefGoogle ScholarPubMed
22.Jefferson, T, Demicheli, V. Quality of economic evaluations in health care. BMJ. 2002;324:313–314.CrossRefGoogle ScholarPubMed
23.Elliott, RA, Barber, N, Horne, R. Cost-effectiveness of adherence-enhancing interventions: A quality assessment of the evidence. Ann Pharmacother. 2005;39:508–515.CrossRefGoogle Scholar
24.Cadosch, D, Bonhoeffer, S, Kouyos, R. Assessing the impact of adherence to anti-retroviral therapy on treatment failure and resistance evolution in HIV. J R Soc Interface. 2012;7:2309–2320.CrossRefGoogle Scholar
25.Parsons, JT, Golub, SA, Rosof, E, Holder, C. Motivational interviewing and cognitive-behavioral intervention to improve HIV medication adherence among hazardous drinkers: A randomized controlled trial. JAIDS. 2007;46:443–450.Google ScholarPubMed
Supplementary material: File

Mathes Supplementary Material

Sup Mat 1

Download Mathes Supplementary Material(File)
File 27.6 KB
Supplementary material: File

Mathes Supplementary Material

Sup Mat 2

Download Mathes Supplementary Material(File)
File 26.6 KB
Supplementary material: File

Mathes Supplementary Material

Sup Mat 3

Download Mathes Supplementary Material(File)
File 111.6 KB
Supplementary material: File

Mathes Supplementary Material

Sup Mat 4

Download Mathes Supplementary Material(File)
File 58.4 KB