Cost Effectiveness Analysis of Clinically Driven versus Routine Laboratory Monitoring of Antiretroviral Therapy in Uganda and Zimbabwe

Antonieta Medina Lara, Jesse Kigozi, Jovita Amurwon, Lazarus Muchabaiwa, Barbara Nyanzi Wakaholi, Ruben E Mujica Mota, A Sarah Walker, Ronnie Kasirye, Francis Ssali, Andrew Reid, Heiner Grosskurth, Abdel G Babiker, Cissy Kityo, Elly Katabira, Paula Munderi, Peter Mugyenyi, James Hakim, Janet Darbyshire, Diana M Gibb, Charles F Gilks and on behalf of the DART Trial Team

PLOS ONE, 2012, vol. 7, issue 4, 1-10

Abstract: Background: Despite funding constraints for treatment programmes in Africa, the costs and economic consequences of routine laboratory monitoring for efficacy and toxicity of antiretroviral therapy (ART) have rarely been evaluated. Methods: Cost-effectiveness analysis was conducted in the DART trial (ISRCTN13968779). Adults in Uganda/Zimbabwe starting ART were randomised to clinically-driven monitoring (CDM) or laboratory and clinical monitoring (LCM); individual patient data on healthcare resource utilisation and outcomes were valued with primary economic costs and utilities. Total costs of first/second-line ART, routine 12-weekly CD4 and biochemistry/haematology tests, additional diagnostic investigations, clinic visits, concomitant medications and hospitalisations were considered from the public healthcare sector perspective. A Markov model was used to extrapolate costs and benefits 20 years beyond the trial. Results: 3316 (1660LCM;1656CDM) symptomatic, immunosuppressed ART-naive adults (median (IQR) age 37 (32,42); CD4 86 (31,139) cells/mm3) were followed for median 4.9 years. LCM had a mean 0.112 year (41 days) survival benefit at an additional mean cost of $765 [95%CI:685,845], translating into an adjusted incremental cost of $7386 [3277,dominated] per life-year gained and $7793 [4442,39179] per quality-adjusted life year gained. Routine toxicity tests were prominent cost-drivers and had no benefit. With 12-weekly CD4 monitoring from year 2 on ART, low-cost second-line ART, but without toxicity monitoring, CD4 test costs need to fall below $3.78 to become cost-effective (

Date: 2012
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0033672

DOI: 10.1371/journal.pone.0033672

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