Author | Luz, Paula M. | |
Author | Morris, Bethany L. | |
Author | Grinsztejn, Beatriz | |
Author | Freedberg, Kenneth A. | |
Author | Veloso, Valdiléa G. | |
Author | Walensky, Rochelle P. | |
Author | Losina, Elena | |
Author | Nakamura, Yoriko M. | |
Author | Girouard, Michael P. | |
Author | Sax, Paul E. | |
Author | Struchiner, Claudio J. | |
Author | Paltiel, A. David | |
Access date | 2018-10-18T18:39:31Z | |
Available date | 2018-10-18T18:39:31Z | |
Document date | 2015 | |
Citation | LUZ, Paula M. et al. Cost-effectiveness of genotype testing for primary resistance in Brazil. Journal of Acquired Immune Deficiency Syndromes, v. 68, n. 2, p. 152-161, 2015. | pt_BR |
ISSN | 1525-4135 | pt_BR |
URI | https://www.arca.fiocruz.br/handle/icict/29643 | |
Language | eng | pt_BR |
Rights | restricted access | pt_BR |
Title | Cost-effectiveness of genotype testing for primary resistance in Brazil | pt_BR |
Type | Article | pt_BR |
DOI | 10.1097/QAI.0000000000000426 | |
Abstract | Objective: HIV genotype-resistance testing can help identify more effective antiretroviral treatment (ART) regimens for patients, substantially increasing the likelihood of viral suppression and immune recovery. We sought to evaluate the cost-effectiveness of genotype-resistance testing before first-line ART initiation in Brazil.
Design: We used a previously published microsimulation model of HIV disease (CEPAC-International) and data from Brazil to compare the clinical impact, costs, and cost-effectiveness of initial genotype testing (Genotype) with no initial genotype testing (No genotype). Methods: Model parameters were derived from the HIV Clinical Cohort at the Evandro Chagas Clinical Research Institute and from published data, using Brazilian sources whenever possible. Baseline patient characteristics included 69% male, mean age of 36 years (SD, 10 years), mean CD4 count of 347 per microliter (SD, 300/µL) at ART initiation, annual ART costs from 2012 US $1400 to US $13,400, genotype test cost of US $230, and primary resistance prevalence of 4.4%. Life expectancy and costs were discounted 3% per year. Genotype was defined as "cost-effective" compared with No Genotype if its incremental cost-effectiveness ratio was less than 3 times the 2012 Brazilian per capita GDP of US $12,300. Results: Compared with No genotype, Genotype increased life expectancy from 18.45 to 18.47 years and reduced lifetime cost from US $45,000 to $44,770; thus, in the base case, Genotype was cost saving. Genotype was cost-effective at primary resistance prevalence as low as 1.4% and remained cost-effective when subsequent-line ART costs decreased to 30% of baseline value. Cost-inefficient results were observed only when simultaneously holding multiple parameters to extremes of their plausible ranges. Conclusions: Genotype-resistance testing in ART-naive individuals in Brazil will improve survival and decrease costs and should be incorporated into HIV treatment guidelines in Brazil. | pt_BR |
Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil. | pt_BR |
Affilliation | Division of General Medicine. The Medical Practice Evaluation Center. USA. | pt_BR |
Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil. | pt_BR |
Affilliation | Division of General Medicine. The Medical Practice Evaluation Center. USA./ Massachusetts General Hospital. Division of Infectious Disease. Boston, MA, USA / Harvard Medical School. Harvard University Center for AIDS Research. Boston, MA, USA / Boston University School of Public Health. Department of Epidemiology. Boston, MA, USA / Harvard School of Public Health. Department of Health Policy and Management. Boston, MA. USA. | pt_BR |
Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil. | pt_BR |
Affilliation | Division of General Medicine. The Medical Practice Evaluation Center. USA./ Massachusetts General Hospital. Division of Infectious Disease. Boston, MA, USA / Harvard Medical School. Harvard University Center for AIDS Research. Boston, MA, USA / Brigham and Women's Hospital. Department of Medicine. Division of Infectious Disease. Boston, MA, USA. | pt_BR |
Affilliation | The Medical Practice Evaluation Center. Brigham and Women's Hospital. Department of Orthopedic Surgery. Boston, MA, USA / Boston University School of Public Health. Department of Biostatistics. Boston, MA, USA. | pt_BR |
Affilliation | Division of General Medicine. The Medical Practice Evaluation Center. USA. | pt_BR |
Affilliation | Division of General Medicine. The Medical Practice Evaluation Center. USA. | pt_BR |
Affilliation | Harvard Medical School. Harvard University Center for AIDS Research. Boston, MA, USA / Brigham and Women's Hospital. Department of Medicine. Division of Infectious Disease. Boston, MA, USA. | pt_BR |
Affilliation | Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil. | pt_BR |
Affilliation | Yale School of Public Health. New Haven, CT, USA. | pt_BR |
Subject | Genotype | pt_BR |
Subject | Cost-effectiveness | pt_BR |
Subject | Brazil | pt_BR |
Subject | HIV | pt_BR |
Subject | Drug resistance | pt_BR |
Embargo date | 2028-08-30 | |