Journal Article

Should Resistance Testing Be Performed for Treatment-Naive HIV-Infected Patients? A Cost-Effectiveness Analysis

Paul E. Sax, Runa Islam, Rochelle P. Walensky, Elena Losina, Milton C. Weinstein, Sue J. Goldie, Sara N. Sadownik and Kenneth A. Freedberg

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 41, issue 9, pages 1316-1323
Published in print November 2005 | ISSN: 1058-4838
Published online November 2005 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/496984
Should Resistance Testing Be Performed for Treatment-Naive HIV-Infected Patients? A Cost-Effectiveness Analysis

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Methods.We utilized a state-transition model of HIV disease to project life expectancy, costs, and cost-effectiveness in a hypothetical cohort of antiretroviral-naive patients with chronic HIV infection. On the basis of a US survey of treatment-naive patients from the Centers for Disease Control and Prevention, we used a baseline prevalence of drug resistance of 8.3%.

Results.A strategy of genotype-resistance testing at initial diagnosis of HIV infection increased per-person quality-adjusted life expectancy by 1.0 months, with an incremental cost-effectiveness ratio of $23,900 per quality-adjusted life-year gained, compared with no genotype testing. The cost-effectiveness ratio for resistance testing remained less than $50,000 per quality-adjusted life-year gained, unless the prevalence of resistance was ⩽1%, a level lower than those reported in most regions of the United States and Europe. In sensitivity analyses, the cost-effectiveness remained favorable through wide variations in baseline assumptions, including variations in genotype cost, prevalence of resistance overall and to individual drug classes, and sensitivity of resistance testing.

Conclusions.Genotype-resistance testing of chronically HIV-infected, antiretroviral-naive patients is likely to improve clinical outcomes and is cost-effective, compared with other HIV care in the United States. Resistance testing at the time of diagnosis should be the standard of care.

Journal Article.  4815 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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