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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

^* To whom correspondence should be addressed. E-mail: gzaric{at}ivey.uwo.ca.

	Abstract

Objective: Inadequate adherence to highly active antiretroviraltherapy (HAART) mayleadto poorhealthoutcomes andthe development ofHIV strainsthatare resistantto 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 effectiveasestimated in thebasecase(in termsofthe 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. Key words: cost-effectiveness; adherence; HIV; counseling; computer simulation. (Med DecisMaking XXXX;XX:xx–xx)

First published on March 18, 2008, doi:10.1177/0272989X07312714

Medical Decision Making 2008;28:359.

A more recent version of this article appeared on June 1, 2008


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