The Cost-Effectiveness of Financial Incentives for Viral Suppression: HPTN 065 Study.
Journal
Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research
ISSN: 1524-4733
Titre abrégé: Value Health
Pays: United States
ID NLM: 100883818
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
21
01
2018
revised:
15
07
2018
accepted:
02
09
2018
entrez:
4
2
2019
pubmed:
4
2
2019
medline:
23
3
2019
Statut:
ppublish
Résumé
To evaluate the cost-effectiveness of financial incentives for human immunodeficiency virus (HIV) viral suppression compared to standard of care. Mathematical model of 2-year intervention offering financial incentives ($70 quarterly) for viral suppression (<400 copies/ml A disease progression model with HIV transmission risk equations was developed following guidelines from the Second Panel on Cost-Effectiveness in Health and Medicine. We used health care sector and societal perspectives, 3% discount rate, and lifetime horizon. Data sources included trial data (baseline N = 16,208 patients), CDC HIV Surveillance data, and published literature. Outcomes were costs (2017 USD), quality-adjusted life years (QALYs), HIV infections prevented, and incremental cost-effectiveness ratio (ICER). Financial incentives for viral suppression were estimated to be cost-saving from a societal perspective and cost-effective ($49,877/QALY) from a health care sector perspective. Compared to the standard of care, financial incentives gain 0.06 QALYs and lower discounted lifetime costs by $4210 per patient. The model estimates that incentivized patients transmit 9% fewer infections than the standard-of-care patients. In the sensitivity analysis, ICER 95% credible intervals ranged from cost-saving to $501,610/QALY with 72% of simulations being cost-effective using a $150,000/QALY threshold. Modeling results are limited by uncertainty in efficacy from the clinical trial. Financial incentives, as used in HTPN 065, are estimated to improve quality and length of life, reduce HIV transmissions, and save money from a societal perspective. Financial incentives offer a promising option for enhancing the benefits of medication in the United States.
Identifiants
pubmed: 30711064
pii: S1098-3015(18)33272-8
doi: 10.1016/j.jval.2018.09.001
pmc: PMC6362462
mid: NIHMS1511500
pii:
doi:
Substances chimiques
Anti-HIV Agents
0
Anti-Retroviral Agents
0
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
194-202Subventions
Organisme : AHRQ HHS
ID : T32 HS013853
Pays : United States
Organisme : NIAID NIH HHS
ID : UM1 AI068617
Pays : United States
Organisme : NIAID NIH HHS
ID : UM1 AI068619
Pays : United States
Informations de copyright
Copyright © 2019 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.
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