Cost and Cost-Effectiveness of Incentives for Viral Suppression in People Living with HIV.
Antiretroviral medication adherence
Cost-effectiveness
HIV
Incentives
QALYs
Journal
AIDS and behavior
ISSN: 1573-3254
Titre abrégé: AIDS Behav
Pays: United States
ID NLM: 9712133
Informations de publication
Date de publication:
Mar 2022
Mar 2022
Historique:
accepted:
13
08
2021
pubmed:
27
8
2021
medline:
16
2
2022
entrez:
26
8
2021
Statut:
ppublish
Résumé
Only 63% of people living with HIV in the United States are achieving viral suppression. Structural and social barriers limit adherence to antiretroviral therapy which furthers the HIV epidemic while increasing health care costs. This study calculated the cost and cost-effectiveness of a contingency management intervention with cash incentives. People with HIV and detectable viral loads were randomized to usual care or an incentive group. Individuals could earn up to $3650 per year if they achieved and maintained an undetectable viral load. The average 1-year intervention cost, including incentives, was $4105 per patient. The average health care costs were $27,189 per patient in usual care and $35,853 per patient in the incentive group. We estimated a cost of $28,888 per quality-adjusted life-year (QALY) gained, which is well below accepted cost-per-QALY thresholds. Contingency management with cash incentives is a cost-effective intervention for significantly increasing viral suppression.
Identifiants
pubmed: 34436714
doi: 10.1007/s10461-021-03439-x
pii: 10.1007/s10461-021-03439-x
doi:
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
795-804Subventions
Organisme : National Institute of Allergy and Infectious Diseases
ID : R01AI117065
Organisme : NIDA NIH HHS
ID : T32DA07209
Pays : United States
Organisme : NIDA NIH HHS
ID : T32DA07209
Pays : United States
Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Centers for Disease Control and Prevention (CDC). HIV basic statistics. 2020. https://www.cdc.gov/hiv/basics/statistics.html#how-many-people-have-hiv-in-US .
Freedberg KA, Losina E, Weinstein MC, et al. The cost effectiveness of combination antiretroviral therapy for HIV disease. N Engl J Med. 2001;344(11):824–31. https://doi.org/10.1056/NEJM200103153441108 .
doi: 10.1056/NEJM200103153441108
pubmed: 11248160
Mai HT, Le GM, Tran BX, et al. Adherence to antiretroviral therapy among HIV/AIDS patients in the context of early treatment initiation in Vietnam. Patient Prefer Adherence. 2018;12:2131–7. https://doi.org/10.2147/PPA.S175474 .
doi: 10.2147/PPA.S175474
pubmed: 30349207
pmcid: 6188958
Centers for Disease Control and Prevention (CDC). Ending HIV transmission, VitalSigns. 2019. https://www.cdc.gov/vitalsigns/test-treat-prevent/index.html .
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(8):632–41. https://doi.org/10.1016/j.amjmed.2003.07.007 .
doi: 10.1016/j.amjmed.2003.07.007
pubmed: 14656616
Mathes T, Pieper D, Antoine SL, Eikermann M. Cost-effectiveness of adherence interventions for highly active antiretroviral therapy: a systematic review. Int J Technol Assess Health Care. 2013;29(3):227–33. https://doi.org/10.1017/S0266462313000317 .
doi: 10.1017/S0266462313000317
pubmed: 23759359
Simon-Tuval T, Neumann PJ, Greenberg D. Cost-effectiveness of adherence-enhancing interventions: a systematic review. Expert Rev Pharmacoecon Outcomes Res. 2016;16(1):67–84. https://doi.org/10.1586/14737167.2016.1138858 .
doi: 10.1586/14737167.2016.1138858
pubmed: 26732615
Freedberg KA, Hirschhorn LR, Schackman BR, et al. Cost-effectiveness of an intervention to improve adherence to antiretroviral therapy in HIV-infected patients. J Acquir Immune Defic Syndr Hum Retrovirol. 2006;43(Suppl 1):S113–8. https://doi.org/10.1097/01.qai.0000248334.52072.25 .
doi: 10.1097/01.qai.0000248334.52072.25
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(3):359–76. https://doi.org/10.1177/0272989X07312714 .
doi: 10.1177/0272989X07312714
pubmed: 18349433
pmcid: 3243050
Neumann PJ, Cohen JT, Weinstein MC. Updating cost-effectiveness—the curious resilience of the $50,000-per-QALY threshold. N Engl J Med. 2014;371(9):796–7. https://doi.org/10.1056/NEJMp1405158 .
doi: 10.1056/NEJMp1405158
pubmed: 25162885
Cameron D, Ubels J, Norström F. On what basis are medical cost-effectiveness thresholds set? Clashing opinions and an absence of data: a systematic review. Glob Health Action. 2018;11(1):1447828. https://doi.org/10.1080/16549716.2018.1447828 .
doi: 10.1080/16549716.2018.1447828
pubmed: 29564962
pmcid: 5930346
El-Sadr WM, Donnell D, Beauchamp G, et al. Financial incentives for linkage to care and viral suppression among HIV-positive patients: a randomized clinical trial (HPTN 065). JAMA Intern Med. 2017;177(8):1083–92. https://doi.org/10.1001/jamainternmed.2017.2158 .
doi: 10.1001/jamainternmed.2017.2158
pubmed: 28628702
pmcid: 5604092
Metsch LR, Feaster DJ, Gooden L, et al. Effect of patient navigation with or without financial incentives on viral suppression among hospitalized patients with HIV infection and substance use: a randomized clinical trial. JAMA. 2016;316(2):156–70. https://doi.org/10.1001/jama.2016.8914 .
doi: 10.1001/jama.2016.8914
pubmed: 27404184
pmcid: 5339876
Bassett IV, Wilson D, Taaffe J, Freedberg KA. Financial incentives to improve progression through the HIV treatment cascade. Curr Opin HIV AIDS. 2015;10(6):451–63. https://doi.org/10.1097/COH.0000000000000196 .
doi: 10.1097/COH.0000000000000196
pubmed: 26371461
pmcid: 4699403
Silverman K, Holtyn AF, Rodewald AM, et al. Incentives for viral suppression in people living with HIV: a randomized clinical trial. AIDS Behav. 2019;23(9):2337–46. https://doi.org/10.1007/s10461-019-02592-8 .
doi: 10.1007/s10461-019-02592-8
pubmed: 31297681
pmcid: 6768703
Zarkin GA, Dunlap LJ, Homsi G. The substance abuse services cost analysis program (SASCAP): a new method for estimating drug treatment services costs. Eval Program Plan. 2004;27(1):35–43. https://doi.org/10.1016/j.evalprogplan.2003.09.002 .
doi: 10.1016/j.evalprogplan.2003.09.002
Bray JW, Zarkin GA, Miller WR, et al. Measuring economic outcomes of alcohol treatment using the Economic Form 90. J Stud Alcohol Drugs. 2007;68(2):248–55. https://doi.org/10.15288/jsad.2007.68.248 .
doi: 10.15288/jsad.2007.68.248
pubmed: 17286343
McCollister K, Yang X, Sayed B, French MT, Leff JA, Schackman BR. Monetary conversion factors for economic evaluations of substance use disorders. J Subst Abuse Treat. 2017;81:25–34. https://doi.org/10.1016/j.jsat.2017.07.008 .
doi: 10.1016/j.jsat.2017.07.008
pubmed: 28847452
pmcid: 5654317
Gebo KA, Fleishman JA, Conviser R, et al. Contemporary costs of HIV healthcare in the HAART era. AIDS. 2010;24(17):2705–15. https://doi.org/10.1097/QAD.0b013e32833f3c14 .
doi: 10.1097/QAD.0b013e32833f3c14
pubmed: 20859193
Holtgrave DR, Wolitski RJ, Pals SL, et al. Cost-utility analysis of the housing and health intervention for homeless and unstably housed persons living with HIV. AIDS Behav. 2013;17(5):1626–31. https://doi.org/10.1007/s10461-012-0204-3 .
doi: 10.1007/s10461-012-0204-3
pubmed: 22588529
Li Z, Purcell DW, Sansom SL, Hayes D, Hall HI. Vital signs: HIV transmission along the continuum of care—United States, 2016. MMWR Morb Mortal Wkly Rep. 2019;68(11):267–72. https://doi.org/10.15585/mmwr.mm6811e1 .
doi: 10.15585/mmwr.mm6811e1
pubmed: 30897075
pmcid: 6478059
Farnham PG, Holtgrave DR, Gopalappa C, Hutchinson AB, Sansom SL. Lifetime costs and quality-adjusted life years saved from HIV prevention in the test and treat era. J Acquir Immune Defic Syndr Hum Retrovirol. 2013;64(2):e15–8. https://doi.org/10.1097/QAI.0b013e3182a5c8d4 .
doi: 10.1097/QAI.0b013e3182a5c8d4
Hall HI, Holtgrave DR, Maulsby C. HIV transmission rates from persons living with HIV who are aware and unaware of their infection. AIDS. 2012;26(7):893–6. https://doi.org/10.1097/QAD.0b013e328351f73f .
doi: 10.1097/QAD.0b013e328351f73f
pubmed: 22313960
Airoldi M, Zaccarelli M, Bisi L, et al. One-pill once-a-day HAART: a simplification strategy that improves adherence and quality of life of HIV-infected subjects. Patient Prefer Adherence. 2010;4:115–25.
pubmed: 20517472
pmcid: 2875721
Sanders GD, Neumann PJ, Basu A, et al. Recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses: second panel on cost-effectiveness in health and medicine. JAMA. 2016;316(10):1093–103. https://doi.org/10.1001/jama.2016.12195 .
doi: 10.1001/jama.2016.12195
Bingham A, Shrestha RK, Khurana N, Jacobson EU, Farnham PG. Estimated lifetime HIV-related medical costs in the United States. Sex Transm Dis. 2021;48(4):299–304. https://doi.org/10.1097/OLQ.0000000000001366 .
doi: 10.1097/OLQ.0000000000001366
pubmed: 33492100
Shrestha RK, Chavez PR, Noble M, et al. Estimating the costs and cost-effectiveness of HIV self-testing among men who have sex with men, United States. J Int AIDS Soc. 2020;23(1): e25445. https://doi.org/10.1002/jia2.25445 .
doi: 10.1002/jia2.25445
pubmed: 31960580
pmcid: 6970935
McKenney J, Chen A, Hoover KW, et al. Optimal costs of HIV pre-exposure prophylaxis for men who have sex with men. PLoS ONE. 2017;12(6): e0178170. https://doi.org/10.1371/journal.pone.0178170 .
doi: 10.1371/journal.pone.0178170
pubmed: 28570572
pmcid: 5453430
Glick HA, Doshi JA, Sonnad SS. Economic evaluation in clinical trials. New York: Oxford University Press; 2014.
doi: 10.1093/med/9780199685028.001.0001
Fenwick E, Claxton K, Sculpher M. Representing uncertainty: the role of cost-effectiveness acceptability curves. Health Econ. 2001;10(8):779–87. https://doi.org/10.1002/hec.635 .
doi: 10.1002/hec.635
pubmed: 11747057
Fenwick E, Marshall DA, Levy AR, Nichol G. Using and interpreting cost-effectiveness acceptability curves: an example using data from a trial of management strategies for atrial fibrillation. BMC Health Serv Res. 2006;6(1):52. https://doi.org/10.1186/1472-6963-6-52 .
doi: 10.1186/1472-6963-6-52
pubmed: 16623946
pmcid: 1538588
Krebs E, Enns B, Wang L, et al. Developing a dynamic HIV transmission model for 6 US cities: an evidence synthesis. PLoS ONE. 2019;14(5):e0217559.
doi: 10.1371/journal.pone.0217559
Whitham HKHA, Shrestha RK, Kuppermann M, Grund B, Shouse RL, Sansom SL. Health utility estimates and their application to HIV prevention in the United States: implications for cost-effectiveness modeling and future research needs. MDM Policy Pract. 2020;5(2):2381468320936219.
pubmed: 32864453
pmcid: 7432967