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The Cost-Effectiveness of Counseling Strategies to Improve Adherence to Highly Active Antiretroviral Therapy among Men Who Have Sex with Men

Author

Listed:
  • Gregory S. Zaric

    (Ivey School of Business, University of Western Ontario, London, Ontario, Canada, gzaric@ivey.uwo.ca)

  • Ahmed M. Bayoumi

    (Centre for Research on Inner City Health, The Keenan Research Centre in the Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Ontario)

  • Margaret L. Brandeau

    (Department of Management Science and Engineering, Stanford University, Stanford, California)

  • Douglas K. Owens

    (VA Palo Alto Health Care System, Palo Alto, California, Center for Primary Care and Outcomes Research, Department of Medicine, Department of Health Research and Policy, Stanford University Medical School, Stanford, California)

Abstract

Objective: Inadequate adherence to highly active antiretroviral therapy (HAART) may lead to poor health outcomes and the development of HIV strains that are resistant to HAART. The authors developed a model to evaluate the cost-effectiveness of counseling interventions to improve adherence to HAART among men who have sex with men (MSM). Methods. The authors developed a dynamic compartmental model that incorporates HIV treatment, adherence to treatment, and infection transmission and progression. All data estimates were obtained from secondary sources. The authors evaluated a counseling intervention given prior to initiation of HAART and before all changes in drug regimens, combined with phone-in support while on HAART. They considered a moderate-prevalence and a high-prevalence population of MSM. Results. If the impact of HIV transmission is ignored, the counseling intervention has a cost-effectiveness ratio of $25,500 per quality-adjusted life year (QALY) gained. When HIV transmission is included, the cost-effectiveness ratio is much lower: $7400 and $8700 per QALY gained in the moderate- and high-prevalence populations, respectively. When the intervention is twice as costly per counseling session and half as effective as estimated in the base case (in terms of the number of individuals who become highly adherent, and who remain highly adherent), then the intervention costs $17,100 and $19,600 per QALY gained in the 2 populations, respectively. Conclusions. Counseling to improve adherence to HAART increased length of life, modestly reduced HIV transmission, and cost substantially less than $50,000 per QALY gained over a wide range of assumptions but did not reduce the proportion of drug-resistant strains. Such counseling provides only modest benefit as a tool for HIV prevention but can provide significant benefit for individual patients at an affordable cost.

Suggested Citation

  • Gregory S. Zaric & Ahmed M. Bayoumi & Margaret L. Brandeau & Douglas K. Owens, 2008. "The Cost-Effectiveness of Counseling Strategies to Improve Adherence to Highly Active Antiretroviral Therapy among Men Who Have Sex with Men," Medical Decision Making, , vol. 28(3), pages 359-376, May.
    • Handle: RePEc:sae:medema:v:28:y:2008:i:3:p:359-376
    DOI: 10.1177/0272989X07312714
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    References listed on IDEAS

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    1. Peterson, J.L. & Coates, T.J. & Catania, J.A. & Middleton, L. & Hilliard, B. & Hearst, N., 1992. "High-risk sexual behavior and condom use among gay and bisexual African- American men," American Journal of Public Health, American Public Health Association, vol. 82(11), pages 1490-1494.
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    Cited by:

    1. Ali Ahmed & Juman Abdulelah Dujaili & Lay Hong Chuah & Furqan Khurshid Hashmi & Long Khanh-Dao Le & Saval Khanal & Ahmed Awaisu & Nathorn Chaiyakunapruk, 2023. "Cost-Effectiveness of Anti-retroviral Adherence Interventions for People Living with HIV: A Systematic Review of Decision Analytical Models," Applied Health Economics and Health Policy, Springer, vol. 21(5), pages 731-750, September.
    2. Edward Broughton & Danilo Nunez & Indira Moreno, 2014. "Cost-Effectiveness of Improving Health Care to People with HIV in Nicaragua," Nursing Research and Practice, Hindawi, vol. 2014, pages 1-6, May.

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