Cost-Effectiveness of Genotype Testing for Primary Resistance in Brazil. (1st February 2015)

• Record Type: Journal Article
• Authors: Luz, Paula M.; Morris, Bethany L.; Grinsztejn, Beatriz; Freedberg, Kenneth A.; Veloso, Valdilea G.; Walensky, Rochelle P.; Losina, Elena; Nakamura, Yoriko M.; Girouard, Michael P.; Sax, Paul E.; Struchiner, Claudio J.; Paltiel, A. David
• Is Part Of: Journal of acquired immune deficiency syndromes. Volume 68:Number 2(2015)
• Publication Date: 2015-02-01
• Subjects: genotype -- cost-effectiveness -- Brazil -- HIV -- drug resistance; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome -- Periodicals; AIDS (Disease); Periodicals; 616.9792005
• DOI: 10.1097/QAI.0000000000000426
• Languages: English
• ISSNs: 1525-4135

Abstract

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. Abstract : Supplemental Digital Content is Available in the Text.