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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
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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 

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