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Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa

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  • Andrew N Phillips
  • Valentina Cambiano
  • Fumiyo Nakagawa
  • Loveleen Bansi-Matharu
  • Papa Salif Sow
  • Peter Ehrenkranz
  • Deborah Ford
  • Owen Mugurungi
  • Tsitsi Apollo
  • Joseph Murungu
  • David R Bangsberg
  • Paul Revill

Abstract

Background: Interventions based around objective measurement of adherence to antiretroviral drugs for HIV have potential to improve adherence and to enable differentiation of care such that clinical visits are reduced in those with high adherence. It would be useful to understand the approximate upper limit of cost that could be considered for such interventions of a given effectiveness in order to be cost effective. Such information can guide whether to implement an intervention in the light of a trial showing a certain effectiveness and cost. Methods: An individual-based model, calibrated to Zimbabwe, which incorporates effects of adherence and resistance to antiretroviral therapy, was used to model the potential impact of adherence monitoring-based interventions on viral suppression, death rates, disability adjusted life years and costs. Potential component effects of the intervention were: enhanced average adherence when on ART, reduced risk of ART discontinuation, and reduced risk of resistance acquisition. We considered a situation in which viral load monitoring is not available and one in which it is. In the former case, it was assumed that care would be differentiated based on the adherence level, with fewer clinic visits in those demonstrated to have high adherence. In the latter case, care was assumed to be primarily differentiated according to viral load level. The maximum intervention cost required to be cost effective was calculated based on a cost effectiveness threshold of $500 per DALY averted. Findings: In the absence of viral load monitoring, an adherence monitoring-based intervention which results in a durable 6% increase in the proportion of ART experienced people with viral load

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  • Andrew N Phillips & Valentina Cambiano & Fumiyo Nakagawa & Loveleen Bansi-Matharu & Papa Salif Sow & Peter Ehrenkranz & Deborah Ford & Owen Mugurungi & Tsitsi Apollo & Joseph Murungu & David R Bangsbe, 2016. "Cost Effectiveness of Potential ART Adherence Monitoring Interventions in Sub-Saharan Africa," PLOS ONE, Public Library of Science, vol. 11(12), pages 1-20, December.
  • Handle: RePEc:plo:pone00:0167654
    DOI: 10.1371/journal.pone.0167654
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    References listed on IDEAS

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    1. Karl Claxton & Simon Walker & Steven Palmer & Mark Sculpher, 2010. "Appropriate Perspectives for Health Care Decisions," Working Papers 054cherp, Centre for Health Economics, University of York.
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    1. Juan J. DelaCruz & Christos Giannikos & Andreas Kakolyris & Robert C. Utzinger & Stephen E. Karpiak, 2021. "Cost-Effectiveness Analysis Combining Medical and Mental Health Services for Older Adults with HIV in New York City," Atlantic Economic Journal, Springer;International Atlantic Economic Society, vol. 49(1), pages 43-56, March.

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